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Fermented foods are a no-go if you suffer from histamine intolerance

Histamine Intolerance

If you’re experiencing strange reactions to certain foods that most would consider healthy, you may be suffering from a little known, but not uncommon cause of food intolerance and disease: histamine intolerance.

This food intolerance is difficult to diagnose, has a multifaceted symptom profile, and is often confused with a variety of other conditions. I am in no any way an expert on this topic, but it has come to my attentiona a few times lately and especially when I was researching about eczema. I think that the condition is very relevant to point out.

What is Histamine Intolerance?

Although many people associate histamine only with allergic responses, under normal circumstances it’s an essential molecule performing three important functions. Histamine is primarily:

  • A neurotransmitter, like a chemical messenger, that passes from one neuron to another in the nervous system.
  • A component of stomach acid that helps break down food.
  • An inflammatory response mechanism that dilates blood vessels to enable white cells to quickly reach and neutralize invaders.

When an allergen triggers your immune system, a type of white blood cells called mast cells release histamines during the inflammatory-immune response. This is part of a healthy, balanced immune system.

There are also foods that naturally contain histamine, or trigger the release of histamine in the body. But problems occur when there's an overload of histamine from a dysfunction or deficiency of the enzymes that break histamine down, called histamine N-methyltransferase (HNMT) and diamine oxidase (DAO). Without the enzymes to effectively get rid of excess histamine, the overflow can cause a lot of problems. This is histamine intolerance.

Symptoms of Histamine Intolerance (source)

Whatever the source of histamine, when the total body level exceeds the enzymes' capacity to break it down, symptoms of histamine excess occur. Histamine intolerance manifests itself in a variety of signs and symptoms such as:

  • Itching especially of the skin, eyes, ears, and nose
  • Hives
  • Tissue swelling - especially of facial and oral tissues and sometimes the throat, the latter causing the feeling of “throat tightening”
  • Hypotension (drop in blood pressure)
  • Tachycardia (increased pulse rate, “heart racing”)
  • Symptoms resembling an anxiety or panic attack
  • Chest pain
  • Nasal congestion and runny nose
  • Irritated, watery, reddened eyes)
  • Some types of headaches that differ from those of migraine
  • Fatigue, confusion, irritability
  • Very occasionally loss of consciousness usually lasting for only one or two seconds
  • Digestive tract upset, especially heartburn, "indigestion", and reflux

Not all of these symptoms occur in any single individual, and the severity of symptoms varies, but the pattern of symptoms seems to be consistent for each person.

In addition to the symptoms listed above, excess histamine can make some existing conditions worse. Eczema is an example. Eczema is an inflammatory condition in the skin, sometimes called atopic (allergic) dermatitis. When high histamine foods are consumed, people with less than efficient histamine tolerance may experience an increase in the severity of their eczema.

Suggestions if you have histamine intolerance

The degree of improvement or resolution of the symptoms of histamine excess that can be achieved by diet alone will depend on whether the food sources of histamine can be reduced below a person's limit of tolerance. The histamine-restricted diet detailed below is designed to exclude all known food sources of histamine. However, some people will not achieve relief by diet alone because even by excluding all of the histamine-rich foods their total level of histamine still exceeds their enzymes’ capacity to break it down. In these cases taking antihistamines often helps.

Fermented foods are some of the biggest culprits, since even beneficial bacteria produce histamine during fermentation. In fact, reacting to fermented foods is a classic sign of histamine intolerance, especially if probiotic supplements are well tolerated. Other foods that are high in histamine include:

High-histamine foods

These are the foods that could cause an overload of histamine:

  • Alcohol (including wine)
  • Canned foods
  • Cheeses
  • Chocolate
  • Eggplants
  • Fermented foods (kombucha, kimchi, sauerkraut, yoghurt, buttermilk, kefir)
  • Legumes (chickpeas, soybeans, peanuts)
  • Nuts
  • Processed foods
  • Smoked meat products (bacon, salmon, salami, and ham)
  • Shellfish
  • Spinach
  • Vinegar


  • Cinnamon, cloves, vinegar
  • Chilli powder, anise
  • Curry powder, nutmeg

Foods that release histamine

These foods are low in histamines, but can trigger the release of histamine and create problems for people with histamine intolerance:

  • Avocados
  • Bananas
  • Dates
  • Raisins, currants (fresh or dried)
  • Citrus fruits (kiwi, lemon, lime, pineapple, papaya, plum)
  • Strawberries, raspberries, cranberries
  • Tomatoes

Diamine Oxidase (DAO) enzyme blockers

  • Alcohol
  • Energy drink
  • Teas (black, green, yerba)

Eliminate your problem foods

An elimination diet is the gold standard for uncovering foods that trigger inflammation for you.

Focus on eating fresh foods

Bacterial growth in foods left unrefrigerated can increase histamine. So try to eat fresh foods as often as possible, and freeze leftovers immediately in single-serve portions.

For a low-histamine diet, focus on these foods:

  • Coconut milk
  • A small quantity of cooked egg in a baked product such as pancakes, muffins, and cakes is allowed
  • Fresh wild-caught fish
  • Fresh organic meat
  • Fresh vegetables (except eggplants, tomatoes, and spinach)
  • Gluten-free grains (rice, corn)
  • Herbal teas
  • Non-citrus fresh fruits
  • Rice milk

Heal your gut

Foods aren't the only ways you can overload on histamines. Gut bacteria imbalances of the microbiome can also release histamine and trigger symptoms. Problems like leaky gut syndrome, SIBO, and candida overgrowth could be fuelling your histamine intolerance.

Heal your gut with homemade bone broth and with histamine lowering probiotics.


Early studies on rodents and in test-tubes have shown that certain probiotic strains may help minimise histamine release. The most effective strains are likely to be Lactobacillus rhamnosus or several Bifidobacterium strains, but there is no guarantee they will help.

The probiotic Lactobacillus rhamnosus (and a few others) has shown to down-regulate histamine receptor while also up-regulating anti-inflammatory agents like (IL)-8. In other words: the probiotic turns down the dial on two important allergy/mast cell cell/histamine receptors, while enhancing the activity of anti-inflammatory agents.

In Europe OptiBac contains the mentioned probiotics. For US Probiota is an option.

Just note that we don’t know the optimal dosage for this condition, nor the long-term side effects (if any), so always consult with your doctor first.

Support the liver

Supporting the liver with herbs like milk thistle, artichoke leaf, and wasabi.

Get enough Magnesium

When magnesium levels are low, the body begins to produce histamines. Along with histamine production, magnesium deficiency also results in lower levels of fatty acids on the skin. 

Eat foods that help your body get rid of excess histamines

  • Increasing your intake of foods with vitamin B6, vitamin C, and copper.
  • Vitamin B6: chicken, turkey, and potatoes.
  • Copper: asparagus and liver
  • Vitamin C: fruits and vegetables (except for those high in histamine)
  • Black cumin and quercetin are also two natural medicines that have antihistamine properties.

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All information in this blog is strictly for informational purposes only and should not be taken as medical advice. The statements made in this book have not been evaluated by The Danish Health Authority. The products linked to in this book and any information published in this blog are not intended to diagnose, treat, cure, or prevent any disease. The information provided by this blog is not a substitute for a faceto-face consultation with your physician, and should not be construed as medical advice. The entire contents of this blog are based upon the opinions of Hanne Robinson. By reading and using this blog, you agree to only use this publication for personal informational use and not as a substitute for medical or other professional advice.