functional nutrition

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Alyssa Simpson RD, CDE, CLT
Alyssa Simpson

(602) 422-9800

Sibo Doctor Approved
certified gastrointestinal nutritionist
Sibo Doctor Approved
certified gastrointestinal nutritionist

4-week Low Histamine Diet Plan pdf and Comprehensive Histamine Intolerance Guide

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4-week Low Histamine Diet Plan

Table of Contents

Do you ever wake up feeling ready to conquer the day, only to be met with an unexpected wave of fatigue after that first bite of breakfast? Or perhaps you’re enjoying a delicious meal with friends, only to find yourself battling uncomfortable bloating and digestive distress shortly after. If these scenarios sound all too familiar, histamine intolerance may be the culprit for sabotaging your eating experiences.

Histamine intolerance affects approximately 1-3% of people worldwide, as evidenced by recent studies. Moreover, a 2017 study revealed that a significant 58% of patients with Irritable Bowel Syndrome (IBS) experienced digestive symptoms triggered by histamine-releasing foods.

As a specialized digestive health dietitian focusing on IBS and Small Intestinal Bacterial Overgrowth (SIBO), I frequently encounter histamine intolerance in my practice. Stay tuned for my upcoming blog post later this month, where I dive deeper into the intricacies of histamine intolerance as it relates to gut issues.

The purpose of this blog post is to address a growing frustration shared by both myself as a practitioner and my patients. Despite the increasing understanding of histamine intolerance, practical resources, especially comprehensive recipes and meal plans, are still scarce. In response to this gap, I’ve developed this Low Histamine Diet Plan pdf tailored for my patients. Now, I’m thrilled to share it with you here!

Download your Low Histamine Meal Plan here 

What is Histamine Intolerance

Histamine intolerance happens when the body has trouble breaking down histamine, a chemical that is produced by the body but also found in certain foods. This occurs because of a shortage of diamine oxidase (DAO), an enzyme that normally helps metabolize histamine. Without enough DAO, histamine builds up in the body, causing a range of symptoms.

DAO and Histamine Intolerance

Diamine oxidase (DAO) is an important enzyme produced in the brush border of the small intestine that breaks down histamine from foods we eat, preventing it from building up too much in the body. However, conditions like Small Intestinal Bacterial Overgrowth (SIBO) can disrupt DAO production, leading to histamine intolerance symptoms. Treating underlying gut issues like SIBO may improve DAO function and relieve histamine intolerance symptoms.

Common Symptoms of Histamine Intolerance:

Common Symptoms of Histamine Intolerance

Histamine intolerance can cause various symptoms throughout the body, such as digestive problems, dizziness, headaches, and sinus-related issues. When my patients show typical digestive issues associated with IBS alongside sinus-related problems resembling allergies, I often consider histamine intolerance as a possible factor.

The Challenge of Low Histamine Diets:

While managing histamine intolerance, navigating a low-histamine diet can be particularly challenging. Histamine is naturally present in many foods, making it difficult to find suitable recipes. Moreover, adhering to such a diet can often feel monotonous and uninspired.

Histamine Intolerance Red Flags

Histamine Intolerance Red Flags

Certain symptoms act as red flags for me, raising suspicion that histamine intolerance is at play. These include:

  • Symptoms increase on a Low FODMAP Elimination: If a patient’s symptoms worsen during the low FODMAP elimination phase, histamine intolerance might be the culprit. This is because reducing FODMAPs can inadvertently increase high-histamine foods in your diet, worsening symptoms for those sensitive to histamine.
  • Very sensitive individuals: These are the ones who tell me “I react to everything,” and don’t tolerate many foods, household chemicals, or supplements.
  • Gastrointestinal symptoms: Predominantly diarrhea, heartburn, bloating, and pain, rather than constipation or end-of-day bloating.
  • Neurological symptoms: Such as headache, anxiety, insomnia, and brain fog.
  • Circulatory symptoms: Such as hot flashes, hypo/hypertension, or rapid heartbeat.
  • Skin issues: Urticaria and eczema are significant red flags.

Anecdotally, these patients often report constant hunger and never feeling full, which may correlate with sugar cravings (histamine intolerance commonly occurs alongside yeast or fungal overgrowth, as histamine and yeast share the same detoxification pathways.)

Identifying Histamine Intolerance

There is no laboratory test for histamine intolerance, so identifying histamine intolerance involves evaluating symptoms, analyzing the diet, and possibly exploring diagnostic tests like blood tests, stool analysis, or breath testing to uncover conditions like SIBO, which can be a clue that histamine intolerance is also at play. Ultimately, diagnosis involves ruling out allergies and observing symptoms improve on a low-histamine diet.

Evaluating Symptoms

Pay attention to histamine intolerance symptoms such as bloating, diarrhea, and allergy-like reactions, noting any patterns related to high histamine foods. Keeping a food and symptom journal is crucial for tracking these symptoms, although interpreting them can be challenging, particularly since histamine symptoms typically manifest more immediately compared to symptoms related to gut imbalances like SIBO, which may develop gradually over time. Seeking guidance from a registered dietitian specializing in gut issues and food intolerances can help in understanding and managing these complexities.

Dietary Analysis

Take a close look at your diet to pinpoint potential histamine sources, such as aged cheeses, fermented foods, cured meats, specific fruits and vegetables, and alcoholic drinks (more listed below). See if your symptoms align with the consumption of these items and consider removing or cutting them down from your diet as an initial step.

Implementing an Elimination Diet

Consider trying an elimination diet to pinpoint trigger foods and gauge how your body reacts. Cut out high-histamine foods temporarily, then slowly reintroduce them while keeping an eye out for any symptoms coming back. This approach can validate histamine intolerance and steer you toward tailored dietary adjustments.

Understanding the Differences Between MCAS and Histamine Intolerance

The low histamine diet is commonly used to ease the symptoms of Mast Cell Activation Syndrome (MCAS). However, while MCAS and histamine intolerance both involve histamine-related symptoms and dietary adjustments, it’s important to recognize the distinct differences between MCAS and histamine intolerance, as these conditions have separate underlying causes and diagnostic criteria. 

Similarities between MCAS and Histamine Intolerance

Histamine-related symptoms are prevalent in both Mast Cell Activation Syndrome (MCAS) and histamine intolerance, manifesting as gastrointestinal distress, headaches, skin reactions, and respiratory issues. Patients with both conditions often find relief through dietary adjustments aimed at reducing histamine intake. In both conditions, the chronic nature of symptoms in both conditions can profoundly affect a person’s quality of life, impacting their daily functioning and overall well-being.

Distinctive Characteristics of Mast Cell Activation Syndrome (MCAS)

MCAS occurs when mast cells become excessively activated, releasing various inflammatory substances alongside histamine. MCAS can be triggered by a range of factors like allergens, stress, medications, and physical activity. Diagnosis often requires specialized tests to measure markers of mast cell activity, such as serum tryptase levels or urinary prostaglandin D2 metabolites, especially during symptom flare-ups.

Distinctive Characteristics of Histamine Intolerance

Histamine intolerance is characterized by impaired histamine metabolism, often due to reduced activity of enzymes like diamine oxidase (DAO) which can happen secondary to digestive issues. Triggered mainly by foods high in histamine or perhaps histamine-releasing substances such as fermented foods, aged cheeses, and alcoholic beverages, diagnosis primarily hinges on clinical symptoms and dietary responses, supported occasionally by laboratory tests.

Distinguishing between MCAS and histamine intolerance is important because of their differing mechanisms and treatments. While both may benefit from a low histamine diet, MCAS requires more comprehensive management beyond diet due to mast cell dysfunction and immune system involvement. Additionally, addressing digestive issues, common in histamine intolerance, alongside dietary changes optimizes symptom relief and overall well-being for these individuals.

Dietary Interventions for Histamine Intolerance

Download your Low Histamine Diet Plan pdf here

To manage histamine intolerance effectively, focus on dietary changes to reduce histamine buildup while being mindful of symptom triggers. Remember, the low histamine diet is a temporary solution; it’s crucial to address the root causes of histamine intolerance for long-term relief. Also, if you have other food sensitivities, continue avoiding those foods while on the low-histamine diet for optimal management.

3 Main Categories of Problem Foods

3 Main Categories of Problem Foods
  1. High Histamine Foods: These directly contribute to histamine levels in the body.
  2. “Histamine Liberators”: These foods are thought to stimulate the release of internal histamine, potentially exacerbating symptoms. However, there is limited evidence supporting how histamine liberators trigger histamine release.
  3. Other Biogenic Amines: Compounds like phenylethylamine, tyramine, and others can interfere with histamine breakdown. However, the extent to which other amines contribute to symptoms remains uncertain. 

Due to limited evidence on how histamine liberators trigger histamine release and uncertainty about the contribution of other amines to symptoms, this blog post and the accompanying meal plan PDF focus mostly on reducing or eliminating high-histamine foods.

Low Histamine Foods to Choose

Low Histamine Foods to Choose
  1. Fresh Meats:
    • Fresh chicken, turkey, beef, lamb, and fish (freshly caught or frozen immediately)
  2. Fresh Vegetables:
    • Leafy greens (lettuce, spinach, kale), broccoli, cauliflower, carrots, cucumber, zucchini, squash, sweet potatoes
  3. Fresh Fruits:
    • Apples, pears, berries (except strawberries), cherries, grapes, melons, peaches, plums
  4. Grains and Starches:
    • Rice (white or brown), quinoa, oats, gluten-free pasta and bread, corn, buckwheat
  5. Dairy Alternatives:
    • Almond milk, coconut milk, rice milk
  6. Fats and Oils:
    • Olive oil, coconut oil, flaxseed oil, avocado oil
  7. Herbs and Spices:
    • Fresh herbs (parsley, cilantro, basil, oregano, thyme), garlic, ginger
  8. Condiments:
    • Apple cider vinegar (in moderation), mustard, pure maple syrup, honey

Foods to Limit or Avoid

Foods to Limit or Avoid
  1. Aged or Fermented Foods:
    • Aged cheeses, fermented soy products (such as soy sauce, miso, tempeh), sauerkraut, kombucha, kimchi, yeast, beer, cider, wine
  2. Vinegar and foods containing vinegar – pickles, salad dressing, mustard, catsup, mayonnaise 
  3. Processed or Cured Meats:
    • Deli meats, sausages, bacon
  4. Canned or Processed Foods:
    • Canned soups, sauces, and vegetables
  5. Certain Fruits:
    • Citrus fruits (oranges, lemons, limes), strawberries, bananas, pineapple
  6. Certain Vegetables:
    • Tomatoes, eggplant, spinach (if not fresh), fermented vegetables
  7. Nuts and Seeds:
    • Walnuts, cashews, peanuts, sesame seeds
  8. Beverages:
    • Alcohol (especially red wine, beer, and champagne), coffee, black tea, green tea, energy drinks
  9. Spices and Condiments:
    • Cinnamon, cloves, vinegar, ketchup, soy sauce, hot sauce

Histamine Diet Nuances

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In addition to naturally high histamine foods like aged cheeses and fermented products, many others can accumulate histamine as they age or undergo processes like fermentation or spoilage, including meats, fish, and certain fruits and vegetables. Therefore, prioritizing fresh, minimally processed foods and freshly prepared meals while avoiding leftovers is crucial for managing histamine intolerance effectively. Considering factors such as food storage and cooking techniques can further reduce histamine levels, and keeping a food diary can help identify trigger foods and optimize management.

Grocery Shopping for Histamine Intolerance

When managing histamine intolerance, making informed choices during grocery shopping is essential, particularly when selecting fresh meat and fish. Here’s a guide to help navigate this aspect of the low-histamine diet:

Purchasing Raw Meat

  • Prefer whole cuts: Opt for whole cuts instead of ground meat or mechanically tenderized meat to lessen bacterial spread.
  • Consider quality: Choose quickly butchered and frozen meat to limit bacterial growth.
  • Freshness Preservation: Purchase meat furthest from the expiration date and freeze promptly.
  • Avoidance of Certain Meats: Steer clear of high-histamine shellfish and pork products.

Purchasing Fish

  • Freshness Priority: Select fish that has been gutted and cooled or frozen promptly to limit histamine formation.

Food Storage & Preparation for Histamine Intolerance

Maintaining food freshness is pivotal for managing histamine intolerance. Here’s how to store and prepare foods effectively:

Freshness Priority

Optimal Consumption: Consume foods in their freshest form to minimize histamine accumulation.

  • Mind storage: Freeze meat as soon as you get home from the grocery store.
  • Timely Cooking: Cook defrosted meat promptly to minimize histamine accumulation.
  • Fruit & Vegetable Handling: Purchase small quantities, store properly, and freeze excess before over-ripening.
  • Meal Freezing: Freeze meals individually to maintain freshness and minimize histamine formation during preparation.

Low Histamine Snacks

Colorful Types of Nouns Inforgaphic

Maintaining a stash of low-histamine snacks can help you stay on track with your dietary restrictions while satisfying your hunger between meals. Here are some ideas for delicious and histamine-friendly snacks:

  1. Fresh Fruits: Opt for fruits with low histamine content such as apples, pears, grapes, and berries. Enjoy them whole or sliced for a refreshing snack.
  2. Vegetable Sticks: Crunchy and hydrating, vegetable sticks like carrot, cucumber, bell pepper, and celery are excellent low histamine options. Pair them with a dip made from yogurt or hummus for added flavor.
  3. Rice Cakes: Plain rice cakes make a versatile base for low histamine toppings. Spread them with almond butter, avocado, or a thin slice of low-histamine cheese (such as fresh mozzarella or cream cheese) for a satisfying snack.
  4. Hard-Boiled Eggs: Hard-boiled eggs are a convenient and nutritious snack option. Enjoy them plain or sprinkle them with a dash of salt and pepper for extra flavor.
  5. Nuts and Seeds: While some nuts and seeds may be high in histamine, others like sunflower seeds and pine nuts are lower in histamine content. Enjoy a small handful as a crunchy and protein-rich snack.
  6. Homemade Smoothies: Blend up a refreshing smoothie using low-histamine fruits like banana, mango, and pineapple. Add some coconut milk or almond milk for creaminess and extra flavor.
  7. Rice Crackers: Look for rice crackers made with minimal ingredients and without added preservatives. Pair them with a slice of low-histamine cheese (such as fresh mozzarella or cream cheese) or some avocado for a satisfying snack.
  8. Homemade Trail Mix: Create your own trail mix using low-histamine nuts and seeds, along with dried fruits like cranberries or apricots. Mix in some dark chocolate chips for a sweet treat.
  9. Yogurt Parfait: Choose a plain yogurt with no added flavors or preservatives and layer it with low-histamine fruits and a sprinkle of granola for a tasty parfait.
  10. Popcorn: Air-popped popcorn is a low-histamine snack option that’s easy to prepare and customize. Sprinkle it with a pinch of salt, herbs, or spices.

Alternatives to Common Trigger Foods

Alternatives to Common Trigger Foods

For individuals managing histamine intolerance, navigating around common trigger foods is essential to minimize symptoms and maintain overall well-being. Here are some alternative options to commonly high histamine foods:


Alternative Options: Opt for dairy-free alternatives such as almond milk, coconut milk, or rice milk. These alternatives can be used in cooking, baking, or enjoyed on their own.

Fermented Foods

Alternative Options: Instead of fermented foods like sauerkraut, kimchi, or pickles, consider incorporating fresh vegetables into your diet. Enjoy raw or lightly cooked vegetables to avoid histamine buildup.

Cured Meats

Alternative Options: Choose fresh, unprocessed meats such as chicken, turkey, or fish. These options are less likely to trigger histamine intolerance symptoms compared to cured or processed meats.

Aged Cheeses

Alternative Options: Opt for fresh cheeses with lower histamine content, such as cottage cheese, ricotta, or mozzarella. These cheeses are less aged and typically contain lower levels of histamine.

Citrus Fruits

Alternative Options: Instead of citrus fruits like oranges, lemons, or grapefruits, try consuming low-histamine fruits such as apples, pears, or berries. These fruits offer similar nutritional benefits without the histamine content.


Alternative Options: Substitute vinegar with lemon juice or apple cider vinegar in recipes. These alternatives provide acidity without the histamine content found in traditional vinegar.


Alternative Options: Satisfy your sweet tooth with carob-based treats or desserts. Carob is a naturally sweet alternative to chocolate and is often well-tolerated by individuals with histamine intolerance.

Yeast-Based Foods

Alternative Options: Replace yeast-based products like bread or baked goods with yeast-free alternatives. Look for quick breads that do not contain yeast, like soda bread, banana bread, or cornbread.

Soy Sauce

Alternative Options: Use coconut aminos or tamari sauce instead of soy sauce. These alternatives offer a similar savory flavor profile without the high histamine content found in traditional soy sauce.


Alternative Options: Enjoy seafood options such as fresh fish or shrimp instead of high-histamine shellfish like crab, lobster, or shrimp. Opt for freshly caught or frozen seafood to minimize histamine levels.

Flavor Enhancers and Low Histamine Condiments

Flavor Enhancers and Low Histamine Condiments

Maintaining flavor and variety in your meals while adhering to a low-histamine diet is essential for a satisfying culinary experience. Here are some flavor enhancers and condiments that are typically considered low histamine options:

Herbs and Spices

Fresh or dried herbs and spices are excellent flavor enhancers for low histamine cooking. Opt for herbs like parsley, basil, cilantro, and thyme, as well as spices such as turmeric, cumin, ginger, and garlic powder.

Fresh Lemon or Lime Juice:

Citrus fruits like lemon and lime can add brightness and acidity to your dishes without introducing high levels of histamine. Squeeze fresh lemon or lime juice over salads, vegetables, or grilled meats for a burst of flavor.

Coconut Aminos

Coconut aminos are a popular alternative to soy sauce and are typically low in histamine. Use coconut aminos to add depth and umami flavor to stir-fries, marinades, or dipping sauces.

Apple Cider Vinegar

Apple cider vinegar is a versatile condiment that can be used to enhance the flavor of dressings, sauces, and marinades. It provides acidity and tanginess without contributing significant histamine levels.


Mustard, particularly Dijon or stone-ground varieties, are generally considered low histamine and can be used to add zing to sandwiches, dressings, or marinades.

Homemade Broths

Prepare homemade broths using low-histamine ingredients such as fresh vegetables, herbs, and lean meats. Simmer them gently to extract flavor and nutrients, then use the broth as a base for soups, stews, or sauces.

Olive Oil

Extra virgin olive oil is a staple in low histamine cooking and can be used for sautéing, roasting, or drizzling over salads. It adds richness and depth of flavor to dishes without contributing histamine.

Fresh Ginger and Garlic

Fresh ginger and garlic are aromatic ingredients that can elevate the flavor of your meals. Grate or mince them and add them to stir-fries, soups, or marinades for a fragrant and savory touch.

Homemade Pesto

Prepare homemade pesto using fresh basil, pine nuts, garlic, olive oil, and Parmesan cheese (if tolerated). Blend them together until smooth and use the pesto as a sauce for pasta, chicken, or vegetables.

Supplements for Histamine Intolerance

Although dietary changes are crucial for managing histamine intolerance, some individuals might find it helpful to include specific nutrients or compounds in their diet to support histamine metabolism or decrease histamine levels. Here are some supplements commonly utilized by people managing histamine intolerance.

Diamine Oxidase (DAO) Enzyme

DAO is the enzyme that breaks down histamine in the body. Taking DAO enzyme capsules before meals can aid in histamine metabolism and alleviate symptoms of histamine intolerance. It’s important to select DAO supplements from trustworthy sources to ensure quality and effectiveness.


Quercetin, a flavonoid present in fruits, vegetables, and herbs, is renowned for its antioxidant and anti-inflammatory effects. It has the potential to stabilize mast cells and decrease histamine release. Quercetin supplements, found in capsule or tablet form, can be taken regularly to assist in managing histamine intolerance.

Vitamin C

Vitamin C is a potent antioxidant known to potentially lower histamine levels and boost immune function.  Taking vitamin C supplements may help regulate histamine release and ease symptoms of histamine intolerance. Opt for a reputable vitamin C supplement and adhere to the suggested dosage instructions for best results.

Finding Your Root Cause of Histamine Intolerance

Histamine intolerance can stem from various underlying factors, and pinpointing the root cause(s) is crucial for managing it effectively. Several common factors that contribute to histamine intolerance include:

  1. Enzyme DeficiencyHistamine intolerance frequently arises due to a deficiency or dysfunction in diamine oxidase (DAO), the enzyme tasked with breaking down histamine in the body.  Factors like genetic predisposition, gastrointestinal issues, or medications that hinder DAO production can lead to diminished DAO activity.
  2. Gastrointestinal Disorders: Conditions like small intestinal bacterial overgrowth (SIBO), leaky gut syndrome, and inflammatory bowel diseases (IBD) such as Crohn’s disease or ulcerative colitis can disrupt the intestinal barrier. This disruption can impair the production or activity of DAO, contributing to histamine intolerance.
  3. Microbiome Imbalance: Changes in the balance of gut bacteria can impact how the body processes histamine. When there’s dysbiosis or an imbalance in gut bacteria, it can result in either more histamine being produced or a decreased ability to break down histamine, which can worsen histamine intolerance.
  4. Medications: Some medications, like nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), and antihistamines, can disrupt the activity of DAO or the metabolism of histamine. This disruption can worsen symptoms of histamine intolerance.
  5. Genetic Predisposition: Some individuals may have genetic differences that impact how their bodies metabolize histamine or make them more susceptible to histamine intolerance. These genetic variations can affect the function of the DAO enzyme, the sensitivity of histamine receptors, and the body’s immune responses to histamine.

Identifying and addressing the root causes of histamine intolerance typically involves a comprehensive evaluation of medical history, dietary habits, gut health, and lifestyle factors. A multidisciplinary approach involving healthcare professionals such as gastroenterologists, allergists, dietitians, and integrative medicine practitioners may be beneficial for personalized management and treatment strategies.

To pinpoint and manage the underlying causes of histamine intolerance, a thorough assessment of medical history, diet, gut health, and lifestyle factors is essential. Collaborating with a qualified gastroenterologist, integrative medicine doctor, or functional nutritionist can offer personalized treatment plans and management strategies.



Yes, reintroducing foods is often a crucial step in managing a low-histamine diet. Here’s a general approach to reintroducing foods:

  1. Start Slowly: Begin by reintroducing one food at a time, preferably those with lower histamine levels or ones you suspect you might tolerate better.
  2. Monitor Symptoms: Pay close attention to any symptoms or reactions you experience after reintroducing a particular food. These may include headaches, flushing, hives, digestive issues, or nasal congestion.
  3. Keep a Food and Symptom Journal: Record the foods you reintroduce and any associated symptoms. This can help you identify patterns and pinpoint which foods are problematic for you.
  4. Gradually Increase Quantity: If you don’t experience any adverse reactions, gradually increase the quantity of the reintroduced food over several days to assess your tolerance.
  5. Wait Between Introductions: Allow a few days between reintroducing each new food to accurately gauge your body’s response and distinguish between potential triggers.
  6. Consider Professional Guidance: If you’re unsure about reintroducing certain foods or if you have severe reactions, consider working with a healthcare professional or a registered dietitian who specializes in food intolerances or allergies (like me!)
  7. Listen to Your Body: Ultimately, listen to your body’s signals. If you notice any adverse reactions or symptoms, it may be best to avoid or limit that particular food in your diet.

Reintroducing foods gradually and methodically can help you identify which ones are well-tolerated and which ones may need to be avoided or limited in your low-histamine diet.

Get Support

Understanding how histamine intolerance, gut health, and food sensitivities intersect is vital for managing digestive wellness effectively. Our 4-week Low Histamine Meal Plan pdf offers tasty options tailored to those with histamine intolerance, empowering you to make enjoyable yet suitable meal choices.

If you need personalized support with gut health and food sensitivities or are curious about the root cause of your issues, I’m ready to provide expert advice and caring guidance. Schedule your free 15-minute consultation here to see how I can help.

If you’re also searching for a supportive community and access to free tips, inspiration, and expert advice, join my free Facebook community.

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