When I was first diagnosed with mast cell activation syndrome (MCAS), and later interstitial cystitis, I was advised to follow a low histamine diet. The doctor I was being treated by handed me a blurry photocopied sheet with a short list of foods that I should avoid. Initially I thought, ‘oh that’s ok, not too many changes to make to my diet’. Then on the train home, I looked at it in more detail and realised that eating a low histamine diet was going to be a little complicated . . .
The food list was rather vague on certain aspects of the restriction. It stated that ‘most nuts’ and ‘most fish’ should be avoided. But that meant some nuts, and some fish, were OK. But which ones? I did some online research and found many different food lists by various organisations and groups. What was really surprising to me were the contradictions within them. It was so confusing, and I had no idea what I could eat and what I should restrict.
To cut a long story short, I saw a dietitian that specialised in the low histamine diet. She suggested (and later several doctors also) that I follow the SIGHI food list for histamine, sticking to foods rated 0-1 on that list. While it isn't always easy, I now really enjoy making low histamine recipes, which I share here on the blog. Often cooking involves making a few alterations, and substituting an ingredient or two in their place. Sometimes I think my version of a recipe tastes even better than the original!
Please ensure that you follow the advice of your doctor in terms of all medical treatments, supplements and dietary choices. This post is for informational purposes only and does not constitute medical advice.
What is a low histamine diet?
A low histamine diet is simply what is says – it includes foods that are low in histamine, and restricts those that are high histamine. It seeks to restrict the amount of histamine that is being ingested through foodstuffs.
My doctors and a dietitian have pointed to the Swiss Interest Group Histamine Intolerance (SIGHI) food list as the most comprehensive, and based on detailed research, but other lists are available. The SIGHI list rates each food individually, rather than ruling out whole food groups, and gives each food a score of 0-3 in terms of how high the level of histamine is. Their book Mast cell-friendly and low histamine cooking: diet guidance and recipe collection is also a great source of information. I have included an overview of the SIGHI list below, but please check it out yourself for more specifics if you plan to follow it. Speaking with a dietician may also be a good idea before you begin.
The next issue is how to store food. It is important to note that histamine increases on foods over time. So keep storage time for leftovers to a minimum (less than 24 hours), and make sure they are in an air-tight container. Buffets or salad bars in cafes or restaurants are likely to be problematic on a low histamine diet. Freezing food as quickly as possible stops histamine formation. When de-frosting do so quickly rather than letting food thaw slowly in a fridge or on the kitchen counter.
Resources for getting started on a low histamine diet
It is not always easy to change your diet, so if you are new to a low histamine diet then you may find it helpful to have a read of my post '10 tips for starting a low histamine diet'. Personally, I prefer to eat fresh food and cook for myself the majority of the time so I know exactly what is in my food, and how long any leftovers have been in the fridge. Saying that, sometimes life gets in the way, and a snack or simple meal (hello cornflakes!) is required. My low histamine diet shopping list page has some great ideas.
I also have a growing collection of low histamine recipes, using the low histamine foods set out below, so head over to that page if you would like some recipes that are high in taste but low in histamine! There are breakfast options, main meals, soups, salads, snacks, sweet treats and jams / sauces. There are many vegetarian, vegan, dairy-free and gluten-free options. Making your favourite meals may also be option with some simple substitutions, so have a look at my easy low histamine diet food swaps post for some inspiration.
Some helpful low histamine cookbooks:
And for those with a sweet tooth, my low histamine sweet treats ebook!
*not all these cookbooks use the SIGHI list.
For those with MCAS, the following posts may be helpful:
Alongside medication and the low histamine diet, I also take the Solgar quercetin everyday as it can be a helpful mast cell stabiliser for some people. This was recommended to me by several doctors, although please check with a medical professional before taking it as some people should avoid this supplement. UK product link: Solgar quercetin.
Low histamine diet food list
This list is an overview of the SIGHI food list for histamine. It rates 'allowed' foods as those scoring 0 or 1 on the SIGHI list, and those scoring 2 or 3, or marked as high histamine or a liberator as restricted. Some foods are given a ? on the SIGHI list, so I have not rated those as high histamine. Please consult the list yourself as it covers a broader range of foods and has more detail. Some patients are advised to only consume foods scoring 0 in the initial stages of this diet, so please consult with a medical professional as per my disclaimer below.
All the foods listed below refer to ‘whole’ or ‘natural’ foods with no additives, preservatives, fillings or sweeteners. It is best to eat food that is freshly prepared, rather than pre-prepared ready meals.
Allowed: all vegetables other than those restricted, as below.
Restricted: aubergine / egg plant; algae; broad beans; brussels sprouts; chili peppers; kelp; olives; onion (white onion OK); mushrooms; nori; sauerkraut; seaweeds; spinach; tomato; tinned vegetables; pickled vegetables (including gherkins and cabbage).
Allowed: apple; apricot; blueberries; blackberry; cherry; gooseberry; mango; melon (except watermelon); nectarine; lychees; peach; pear; pomegranate; redcurrants; rhubarb; grapes are patient-dependant.
Restricted: avocado; banana; grapefruit; guava; lemon; lime; kiwi; mandarin orange; orange; papaya; pineapple; plum; prunes; raspberries; rose hip; strawberries; watermelon.
Allowed: amaranth; bread (check for problematic ingredients); cornflakes (check for problematic ingredients, particularly malt and folic acid); millet; oats; pearl sago; quinoa; rice; rice cakes; rice noodles; rice crispies (free from additives); spelt; corn; hemp seeds; potatoes (keep in a dark place!); wheat - patient-dependant; sweet potato; yam.
Restricted: buckwheat; barley malt, malt; wheatgerm; baked goods with a long fermentation time may not be tolerated.
Dairy, milk and milk substitutes
Allowed: cow's milk / goat / sheep; almond milk; coconut milk; oat milk (can be patient-specific); young cheeses – cream cheese, ricotta, mascarpone, young Gouda; mozzarella, quark; butter; cream, whey.
Restricted: all fermented dairy products; hard, aged cheeses – cheddar, blue, feta etc; sour cream; processed cheese slices; yoghurt; buttermilk; soy milk, kefir, cultured butter.
Meat, poultry, fish and meat substitutes
Allowed: All pure, fresh, frozen beef, duck, chicken and turkey; freshly caught fish and frozen fish (other than those restricted, as below).
Restricted: dried meat; tinned and canned fish; smoked, marinated, salted, dried or pickled fish and seafood; all processed meats; sausages; tuna; anchovies; fish sauces; shellfish; tofu.
Allowed: egg yolk, quail eggs.
Restricted: raw and cooked egg whites.
(please note that eggs are controversial in terms of low histamine diets, some lists state that cooked egg white is low histamine – so please be guided by your dietitian).
Restricted: all beans, lentils and chickpeas; soybeans; tofu.
(please note that legumes are controversial in terms of low histamine diets – so please be guided by your dietitian).
Nuts and seeds
Allowed: all except restricted, as below.
Restricted: walnuts; cashews; pecans; sunflower seeds.
(please note that nuts are controversial in terms of low histamine diets – so please be guided by your dietitian)
Oils and vinegars
Allowed: butter; extra virgin olive oil; coconut oil; rapeseed / canola oil; distilled white vinegar; apple vinegar.
Restricted: walnut oil; sunflower oil; red wine vinegar; white wine vinegar; prepared salad dressings and gravies; balsamic vinegar.
Herbs and spices
Allowed: all fresh, frozen or dried herbs and spices except those restricted below; table salt.
Restricted: aniseed; bouillon; cumin; curry powder; cayenne; chilli; fenugreek; mustard and mustard seeds; chilli powder; yeast extract – including marmite and vegemite (dietician advice); black and white pepper.
(please note that ginger, cinnamon and nutmeg are controversial in terms of low histamine diets, please check with a dietician)
Allowed: agave; sugar; honey; fructose; molasses; maple syrup; stevia.
Restricted: artificial sweeteners; natural sweeteners; flavoured syrups; malt extract; liquorice root.
Allowed: peppermint tea; herbal teas (of non-restricted ingredients); pure juices of allowed fruits and vegetables; coffee – patient specific; elderflower cordial; water.
Restricted: teas – particularly black tea; soy milk; nettle tea; alcohol; Ovaltine; hot chocolate.
Allowed: baking soda; coconut; cocoa butter; white chocolate - patient-dependant.
Restricted: chocolate; carob; cocoa; cocoa mass; soy sauce; mayonnaise.
Please see the SIGHI list, as the list of additives to avoid is long! I tend to cook from fresh and so avoid food additives in that way.
Check out my low histamine recipes collection for lots of tasty meals and treats!
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Disclaimer time . . . if you have a medical condition (or suspect that you do) that requires you to eat a low histamine diet then it is imperative that you consult with a specialist doctor. Histamine issues are potentially very serious and so require careful management from a trained medical professional. I am simply a person with MCAS, and not a doctor or dietitian. I am sharing recipes and food items that I can enjoy, but these should only be followed if it is suitable for your circumstances. Any dietary changes should be undertaken in consultation with a medical professional, and on their expert advice.
This post, as well as all other posts on this blog, are for informational purposes only. All readers of the blog should follow the advice of their doctors and other medical professionals as to the appropriate treatment for any medical conditions. This post, and all others, are not intended to advocate for, or encourage, the use of a low histamine diet, any particular supplements, foodstuffs or products, or act as medical advice in any way. I accept no liability for any harm, whether direct or indirect, or inconsequential, for the use of any information given on this blog. Readers' use of the information on this blog is at their own risk. Please read my disclaimer where I state that under no circumstances am I liable for any harm, injury, damages or losses that arise, whether direct or indirect, as a result of the use or information of the content of this website.