Nutrition with histamine intolerance

You have treated yourself to a tasty tomato salad with fish, along with a few glasses of wine, and afterwards you have stomach ache, palpitations or an itchy rash with weals? “Not again!” you think, because this happens to you quite often. You may have a histamine intolerance. In this article we explain what you should watch out for in your diet with a diagnosis of histamine intolerance.

A histamine intolerance (HIT) is also called histamine incompatibility or histaminosis. People who have HIT cannot tolerate histamine or other biogenic amines (for example serotonin, tyramine or phenylethylamine). Symptoms occur when there is an imbalance between histamine intake, histamine production and histamine breakdown, in other words when the body no longer produces enough DAO (diamine oxidase), for example, or when so much histamine is taken in through food that the system can no longer manage to break it down. Every person has a different tolerance threshold. A value between 0.3 and 1.0 nanograms per millilitre is regarded as normal. Complaints can, however, also occur at lower values or only at higher ones. The further the histamine level rises, the more severe the symptoms become.

These often resemble those of other conditions. The spectrum ranges from digestive complaints all the way to breathing difficulties. Increased tiredness or exhaustion can also occur. Often, though, a food intolerance such as fructose malabsorption can be behind it. Symptoms that, once other intolerances or allergies have been ruled out, can be indications of a histamine intolerance are for example:

• A feeling of fullness
• Diarrhoea
• Period pains
• Headaches and migraine
• Skin reactions (weals and swellings)
• Shortness of breath and asthma-like complaints caused by narrowing of the bronchi
• Circulatory complaints
• A blocked nose
• Stomach cramps
• Increased formation of stomach acid

Do you want to find out more? Then have a look at our detailed article on histamine intolerance.

With a diagnosis of histamine intolerance it is important first of all not to let yourself be discouraged by the list of “forbidden foods”. Instead you should concentrate on which foods you may still eat without restriction. Since every histamine intolerance is different in how strongly it is expressed, you can also use an elimination diet to find out which foods you personally tolerate, even though they are on the “forbidden list”. In any case, a tasty and healthy diet is possible with histamine intolerance too.

The motto is: the fresher the better. The reason for this is that the histamine content can change when a food ripens further. So the riper and older a food is, the more histamine it contains. An example: fish that has just been caught is low in histamine, and if it is not kept cool its histamine content rises. Vegetables and meat too are (with a few exceptions) mostly low in histamine in their original form. Through pickling (preserving), fermentation or longer storage they can, however, develop into veritable “histamine bombs”. The fresher you eat something, the better it can therefore be digested by people with histamine intolerance. The foods should also be free of flavour enhancers (glutamate E 620-625), since these hinder the breakdown of histamine in the body. Along the same lines you should also avoid yeast and yeast extract as well as other flavour enhancers, stock, chilli and other hot spices, vinegar (including balsamic and wine vinegar) or soy sauce.

The way a dish is prepared also has an influence on its histamine content. It is best to use foods straight from the fridge and not to let them warm up to room temperature. Fish and meat dishes should not be reheated (whether in the microwave or in the oven makes no difference).

Yes, you can eat a ketogenic diet with a histamine intolerance too. A ketogenic diet means a diet with the aim of forming ketone bodies. This is achieved through a deliberate choice of ingredients following the motto “low carb but high fat”. Ketone bodies are special molecules that are formed in the liver from fatty acids and supply our body with energy. Ketosis occurs when an increased number of ketone bodies is present in the blood. This is a state of increased fat burning.

In research on the effect of fats on the release of histamine from mast cells, it was proven that some fats lead to an increased release of histamine, while others hardly do so or not at all. You could say a distinction can be made between “suitable” and “unsuitable” fats. The unsuitable fats are all poly-unsaturated fatty acids, and the suitable ones are mono-unsaturated or saturated fatty acids. The latter are exactly the fatty acids that are recommended on a ketogenic diet. An additional plus point: a ketogenic diet can have positive effects on the gut flora. It then forms more enzymes, for example the enzyme diamine oxidase: the enzyme that breaks down histamine in the body.

But take care, here you have to look closely. Just because a food leads to little or no release of histamine, it can still contain a lot of histamine. Fish, for example, contains suitable fatty acids, but some types of fish naturally contain a lot of histamine and are therefore not suitable for people with histamine intolerance.

In addition to the recommended foods named above, here are a few more tips on how a ketogenic diet can be put into practice with histamine intolerance.