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How to do a Low Histamine Diet for Histamine Intolerance and Mast Cell Activation Syndrome Part 1: Identifying High Histamine Foods

Most people with Histamine Intolerance or Mast Cell Activation Syndrome start with a Low Histamine Diet. Why is this? Many foods naturally have histamines in them, and some foods cause the body to release histamine. Other foods block the release of the enzyme Diamine Oxidase (DAO) that breaks down histamine.

The Problem with High Histamine Foods Lists Found Online – Especially if you have Histamine Intolerance or Mast Cell Activation Syndrome

There are a number of high histamine food lists online. Here’s the problem with most histamine food lists. They were created through studies on small groups of people and were not well controlled. This means the researchers usually didn’t know if someone was reacting to histamine in a food or to something else. So, what happened is that many foods that aren’t actually high histamine were put on the do not eat list, and some foods that are high histamine were put on the ok lists.

If you have Mast Cell Activation Syndrome and Histamine Intolerance, you probably have a hard-enough time finding foods you can eat.

Are you interested in working with a practitioner 1:1?  

If so, you can apply to see if the Mast Cell 360 Practice is a good fit for you. Click the button below: 

But don’t worry. I’m going to step you through the validated evidence. This is a 3 part series. And once you are done reading the 3 parts, you’ll know what you can and can’t eat on a Low Histamine Diet.

Part 1: This post – Focuses on identifying high histamine foods.

Part 2: Focuses on what you CAN eat when you have Histamine Intolerance or Mast Cell Activation Syndrome: How to Do a Mast Cell Activation Syndrome Diet

Part 3: Gives you a clear list of High and Low Histamine Foods:
The Mast Cell 360 Starter Low Histamine Diet Foods List & Why you Shouldn’t use Most of the Online Histamine Foods Lists if you have Mast Cell Activation Syndrome or Histamine Intolerance

Of course, if you have any medical issues, please consult with your medical provider before starting any kind of diet.

It is definitely important to identify the foods that are the highest histamine. You’ll want to rule those out. Beyond this, everyone is different in how foods affect them. You want to keep a food and symptoms journal to see how you respond to certain foods. This will allow you to make your own foods lists.

Let’s look at what foods you need to be on the watch out for if you have Histamine Intolerance or Mast Cell Activation Syndrome

What Foods are Definitely High Histamine for people with Histamine Intolerance or Mast Cell Activation Syndrome?

Aged, Cultured, Fermented Foods and Leftovers – Yikes! If you have Histamine Intolerance or Mast Cell Activation Syndrome

One rule of thumb is any foods with bacteria in them can create high histamine. So, anything that is out of date, spoiled, moldy, or not really fresh is higher histamine. This also means leftovers become higher histamine the longer they sit.

That rotisserie chicken at the grocery that has been sitting all day is building high histamine levels. Meat that has been sitting more than a day in the refrigerator section increases in histamines. Fermenting, culturing, and aging increases histamines too. Beef is especially high histamine because it gets aged for at least 2 weeks before going to market. So, look out for these types of high histamine foods:

  • Fermented alcoholic beverages, like wine, champagne, beer, whiskey, brandy
  • Fermented foods: sauerkraut, vinegar, soy sauce, kefir, yogurt, kombucha, etc.
  • Soured foods: sour cream, sour milk, buttermilk, soured bread, etc.
  • Balsamic Vinegar and Vinegar foods: pickles, mayonnaise, olives, ketchup
  • Cured meats: bacon, salami, pepperoni, luncheon meats and hot dogs
  • Aged cheese including goat cheese
  • Smoked fish, fish not gutted within 30 minutes of catch, anchovies, sardines
  • Ground meat (Increased surface area increases histamines)
  • Beef (aging process increases histamine)
  • Smoked or processed meats: salami, bacon, ham, sausage
  • Dried fruit: apricots, prunes, dates, figs, raisins
  • Uncooked egg whites (histamineliberator)
  • Leftovers

Fruits, Vegetables, and Nuts that are High in Histamines and can affect Histamine Intolerance or Mast Cell Activation Syndrome

Next, we’re going to look at which of these foods you need to be careful with. Fortunately, there are just a few fruits, vegetables, and nuts that are the highest in histamines or release histamines. Some of them might surprise you, though. If you are eating these foods, it would be a good idea to track how they affect you. I used to always itch badly when I ate walnuts or pineapple. Spinach made me not be able to sleep. And strawberries gave me a migraine. Do any of these foods bother you?

High Histamine fruits, vegetables and nuts:

  • Walnuts
  • Cashews
  • Peanuts
  • Spinach
  • Mushrooms
  • Eggplant
  • Avocado
  • Pineapple
  • Strawberries
  • Most citrus (small amounts lemons and limes sometimes ok)

Processed Foods and Additives – Big Problems if you have Histamine Intolerance or Mast Cell Activation Syndrome

You want to avoid packaged and processed foods as much as possible. Period. This may seem obvious, but many people with Mast Cell Activation Syndrome still eat lots of packaged foods. Many people think if the label says organic or gluten free then it must be healthy.

Crackers, chips, cereal, and frozen dinners can be a problem. Canned foods, boxed nut milks, cookies, prepared sauces, and protein bars are higher histamine and inflammatory too. Anything that sits in a package becomes higher histamine. Packaged foods are highly processed to make them shelf stable. This destroys the nutrients your body so desperately needs.

Avoid sugar, additives, coloring, flavorings – anything artificial.

In addition to avoiding processed and packaged foods, watch out for these additives that can wreak havoc with mast cells:

  • Carrageenan
  • Sodium Benzoate
  • Potassium Sorbate
  • Lecithin
  • MSG
  • Citric Acid
  • Sodium Triphosphate
  • Potassium Triphosphate
  • Sodium Nitrite
  • Maltodextrin
  • Calcium Chloride
  • Xanthan Gum
  • Food colorings
  • Smoke Flavoring
  • Yeast Extract

So, these are the big ones to avoid. You want to be very careful not to whittle your foods down too much, though. Variety is key to good nutrition. I’m a big advocate of replacing foods rather than eliminating them. So, as you take foods out that are High Histamine, make sure you are replacing them with high nutrient, Low Histamine foods.

A Mast Cell Activation Syndrome and Histamine Intolerance Success Story for You

Joy was very kind to send this to share with you. When we first met, she was really sick and struggling. But she’s doing great now. I’m so happy for her! Stories like this kept me going when I was sick. I hope Joy’s story brings some light into your day, today!

“Before I met Dr. Beth, I could not get rid of chronic Lyme symptoms and I was having so many reactions to foods and environmental insults. I felt like I’d never get better. I didn’t understand Mast Cell Activation Syndrome (MCAS) and Histamine Intolerance so I was mainly going after Lyme and heavy metal toxicity symptoms using herbs, homeopathics and supplements. Turns out I was taking and eating a lot of things (like ferments) that kept me from getting better. I believe now that the Lyme had no longer been an issue for years, and it was actually undiagnosed MCAS as well as underlying issues caused my metals, molds and genetic mutations.

I really wanted to work with someone who understood genetic analysis and how that related to the symptoms I was having. After serendipitously speaking with one of Dr. Beth’s other clients, I suspected I could have MCAS and wanted to address it.

Through working with Dr. Beth, I now understand my genetic issues. I know how to take care of myself around food and environmental triggers. And I now know that I still have heavy metal and mold toxicity to work on to feel 100%.

Working with Dr. Beth’s Mast Cell 360 program has helped me understand MCAS and how oxalates and lectins cause flares for me. I also understand what works and doesn’t work for my body, given my genetics. I am now a new person. I can imagine my future again and I’m taking steps to rebuild my life.

The first thing I noticed were less mast cell reactions. I had been having constant burning mouth and red neck. I even broke into hives when I showered. This went away after about 8 months. My brain fog is nonexistent most of the time (that was a huge issue I was dealing with). My neurological inflammation improved, joint pain improved, and my energy has massively improved. My anxiety and agoraphobia are gone too. My life has changed to nearly normal. I still have improvements to continue to make, but I think I mostly need to increase my stamina which has been on hold for 8 years.

When I had my first Case Review with Dr. Beth, she believed it would take me about 18 months to really feel better. She was right on target! It’s been 16 months and the relief from my symptoms has exponentially grown in the last few months. I will be forever grateful to Dr. Beth for putting me on the road to wellness.”
-Joy E.

Do you need help with your Mast Cell Activation Syndrome or Histamine Intolerance?

Are you interested in working with a practitioner 1:1?  

If so, you can apply to see if the Mast Cell 360 Practice is a good fit for you. Click the button below: 

It’s important you know that this blog post is for informational and educational purposes. It’s not meant to treat any health condition or to be prescriptive for anyone. Always be sure to work with your healthcare practitioner. 

Before you change your diet on your own, please make sure you’re working with a healthcare practitioner who can help you with this. 

What to read next:

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  1. patricia altenau

    this article is so helpful in reviewing foods that are potentially not great for me. thanks for the refresh, i really needed this!

  2. Maria Custer

    Thank you for your blog. It has been really interesting. My integrative doctor thinks this may be an issue for me— along with mold, metals, parasites-oh my! Anyway, curious if there is a cookbook you recommend? Or places to find recipes? I am not much of chef to throw things together on my own. I like to follow recipes. Thank you again!

    1. Beth O'Hara

      Hi Maria, I’m so glad you like the blog. I had mold, metals, and parasites, too, along with Lyme. The good news is it does get better if you can address the underlying issues in the right order and make sure protocols are mast cell friendly.
      I do have a number of recipes here:
      Hope that helps!

  3. Pingback: The Mast Cell 360 Starter Low Histamine Foods List & Why you Shouldn’t use Most of the Online Histamine Foods Lists if you have Mast Cell Activation Syndrome or Histamine Intolerance

  4. Laura Kimball

    Working through this low histamine diet, and looking forward to my consult in the future! All types of radishes have worked well for me, and wondering if the radish greens are low histamine and low lectin as well? thank you,

  5. MF4Mark

    Beth I’m curious on your thoughts. I started looking into leaky gut a year ago as a big cause of my health issues. I scored well above 50 on your histamine quiz- it got to the point where I stopped counting.

    Some people say you need fermented foods to recolonize the gut, others say no avoid. I’m really craving Kimchi, which I’ve learned to make at home. So what about a 3rd path? Eat fermented foods for the health benefits AND supplement with DAO to neutralize the high histamine content?

    1. Beth O'Hara

      Hi Mark,
      Unfortunately, DAO won’t offset that much histamine. You can definitely recolonize and heal the gut without ferments. I work with histamine lowering probiotic strains combined with a prebiotics like this:
      or these 2:
      Or if there is SIBO, without the prebiotics:
      PS – You can also get 15% off anything at Fullscript when you register with the links above.

  6. Greg Hodgman

    What drinks do you recommend ? Green tea, matcha, seltzer, ginger tea? Can they be kept in the fridge?

    1. Beth O'Hara

      Hi Greg,
      Here is a quick reference sheet of foods (and beverages) for you. Some people can tolerate histamine in lower amounts. If you are adhering to a low histamine diet and want to try a tea drink as a treat, it might be something you can do every now and again. It depends on your sensitivity level. Best wishes!

  7. Greg Hodgman

    Which drinks should you avoid? Organic vegetable ? Do you only drink juice made at the moment?

    1. Beth O'Hara

      Fresh is best, but do be mindful of fruit juices due to sugar.

  8. Ann Fonfa

    What about cacoa nibs *unsweetened*? Brewers yeast, pomegranates, apricot seeds, roasted chestnuts, Maca? all items are organic.

    I thought I saw curry powder (which is really a combo of other spices, so is Turmeric an avoid? Thank you

    1. Suz, Mast Cell 360 Team

      Check out Beth’s food list here:
      Poms are lower histamine, but oxalates.
      Apricot seeds, if you are talking about the pit of an apricot, is not really recommended to eat at all.
      Curry Powder is higher histamine. Tumeric is lower histamine but oxalate.
      Chesnuts are lower histamine
      and I can’t find Maca on Beth’s list or in any of our resources.

    2. Suz, Mast Cell 360 Team

      I have some more information for you from Beth:
      Cacoa nibs will be higher histamine
      Brewer’s yeast will also be higher histamine
      Maca continues to be a mystery, but Beth suspects it is likely high

  9. Cheryl

    Thank you so much for your very clear explanations regarding foods and the reasons why they may be high in histamines. This was very informative and easy to understand. Thank you for sharing this!!

  10. Janine

    Do you have an alternative or a suggestion to replace Soy Sauce?

    1. Suz, Mast Cell 360 Team

      Hi Janine,
      There really isn’t something that can be used in all the recipes you would use soy sauce. Most of the things with umami flavor profile are high histamine. Beth does like sesame oil like this one:

      While it might not be suitable for all recipes, it is tasty and could work in many dishes.

      Suz, MC360

  11. Grace

    Thank you so much for this information. I see that dried fruit is on the no-list. What about freeze dried foods? Does it halt the aging process when the water is removed?

    1. Suz, Mast Cell 360 Team

      It helps, but won’t be as low as fresh fruit. Here’s what the spectrum of food looks like in terms of histamine levels: Fresh produce is lowest histamine. Frozen is a little more histamine than fresh but it is still low. Freeze dried will be higher than fresh produce but lower than traditionally dried foods and canned foods.

  12. Monita Freeze

    I noticed that someone mentioned in the blog to take a quiz to see if you have histamine intolerance. Where can I find the quiz? I have allergies that have turned into year round concerns for me. In 2019 I tried a vegan diet for 5 months and then had a massive vertigo attack and brain fog and dizzy spells that went on for the next two years, still have episodes. After the vertigo attack and I could not get back on track with symptoms of dizziness, doctor gave me 6 day course of steroids to get my histamine levels down. Really would like to know if histamine is my issue or not. Thanks!

    1. Suz, Mast Cell 360 Team

      Hi Monita,
      Thanks for reaching out. We have a quiz that helps look at if you have haywire mast cells which you can find here:

      And we have a quiz that asks Do you have more than just histamine intolerance (meaning it may be possible that symptoms are related to Mast Cell Activation Syndrome) which you can find here:

      I’ve checked with the team, and no one remembers a quiz about histamine intolerance. I’m sorry I couldn’t find that for you, but I hope these other two quizzes will help provide you with some answers.

      Here’s an article we refer to as Histamine 101 which may also be helpful for you:

      Best wishes!

  13. Jen

    Is mast cell activation syndrome a healable disease? Even after healing and detoxing extensively? Can I ever go back to normal, as in being able to not be so worried about high histamine foods and being able to order all the high histamine foods at a restaurant that I want whenever? Or is this just a fantasy/dream of mine. Is this a lifetime of making sure my histamine cup isn’t going to “overflow”. This has been a nightmare .

    1. Suz, Mast Cell 360 Team

      Hi Jen,
      Thanks for reaching out. This is a great question and one we get asked a lot. There really is no simple answer. It can depend on a number of different factors.

      For Histamine Intolerance, it depends on the level of genetic variants and if the triggers are fully resolved. If there aren’t significant genetic variants, then histamine intolerance is often overcome. With significant variants, it may need to be supported. With Mast Cell Activation Syndrome, it depends on genetics, age, health history, how much root triggers are addressed, and how well the nervous system has been supported.

      Beth has seen numerous children go back to the way they were before. She see this less in adults, but it does happen sometimes when they work really hard. Most often, she sees people get great improvements, regain their health and their lives, and still have to take good care of their bodies to stay healthy.

      For a long time, Beth was the sickest person she knew and only able to tolerate 10 foods including herbs. She is now able to eat a lot more variety and even high histamine foods like strawberries on occasion. But she does continue to support her health with good diet choices, supplements, and nervous system work.

      She has come from being bed ridden to building a successful practice. Stay hopeful! You can get there, too!

  14. Josie

    The link for Part 2 doesn’t work and the link for Part 3 seems to go to the wrong page. Hoping someone can take a look.

    1. Jamie, Mast Cell 360 Team

      Hi Josie,
      Thanks so much for bringing this to our attention. We were in the process of updating this series and apologize for the mix up with Part 2. The part 2 link should now take you to the correct post. Part 3 is correct.
      Jamie, MC360

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