Over the past few years the low histamine diet seems to have become increasingly recognised amongst various chronic illness communities. While it is pretty common for doctors to advise this diet for those with mast cell activation syndrome or histamine intolerance, I've heard more and more that it may be useful for some people with interstitial cystitis or chronic migraine.
Over on my Instagram I get a lot of DMs about the Swiss Interest Group Histamine Intolerance (SIGHI) food compatibility list for histamine that I follow for MCAS. There are lots of questions about whether it is dairy-free, or nut-free for example, so I've put together some of the key aspects of the SIGHI list, and some other resources on MCAS too. Hope that it is helpful!
Disclaimer: please follow the medical advice of your doctor or medical team. This post is for informational purposes only, and I accept no liability for any direct or indirect harms arising from its content.
- The SIGHI food list and other histamine food lists
- How does the SIGHI diet work?
- Processed food and a low histamine diet
- The SIGHI list and nuts
- The SIGHI list and gluten
- The SIGHI list and cheese
- Starting out on a low histamine diet
- Following the SIGHI list as a vegan
- Do you take supplements to help with MCAS?
- How do you ‘score’ ingredients on your low histamine recipes?
- Books and websites on MCAS
- Low histamine cookbooks
The SIGHI food list and other histamine food lists
Personally I follow the SIGHI food list for histamine as it was advised by my doctors, including my previous immunologist and current uro-gynaecologist (for interstitial cystitis). There are, however, lots of histamine food lists out there, and the SIGHI food list isn't the only one. Some hospitals also give out histamine lists to their patients, although the ones I have been given have a very limited range of foods on them.
When I have looked at other lists, I have found them to be vague (what on earth does 'most fish' or 'some cheese' mean?!) and many don’t state the research behind their suggestions for which are low and high histamine foods. However, everybody should follow the advice of their doctor when undertaking any form of diet, especially a restrictive diet such as a low histamine one. I’m not a doctor, just making recipes using the SIGHI list as a base!
How does the SIGHI diet work?
SIGHI isn’t really a diet as such, rather it is a comprehensive list of foods with a score of their histamine content to guide people who have been advised to eat low histamine by their doctors. It scores foods from 0-3, with 0 being low histamine and 3 high histamine.
So, personally I eat mostly foods that score a 0, with a few ‘1’ foods. If my symptoms are worse then I stick with 0 rated foods. SIGHI doesn’t score branded products or processed foods other than things like cream cheese, vinegars and rice cakes and noodles.
Processed food and a low histamine diet
Eating processed food on a low histamine diet is a question of your personal sensitivities. For me, anything like burgers, take-aways or really processed sweets etc aren’t something I eat, or literally once or twice a year. They tend to be full of MSG and other preservatives, and the reaction I get from them isn’t worth it. It's far nicer just to make my own food!
The term ‘processed’ is quite complex though – foods such as cream cheese, rice cakes, protein powders or certain snacks with low histamine ingredients can be understood to be processed and I eat some of those! If a product has a ton of ingredients that I don’t recognise and can’t pronounce then I tend to steer clear. So, for example, I use the Pulsin brown rice protein powder because it is 100% brown rice concentrate and nothing else. But I wouldn’t eat another brand with a ton of additives and flavourings in it. It really is down to your personal symptoms and how well you can tolerate different foods.
The SIGHI list and nuts
The good news is no, you don’t have to be nut-free if you follow the SIGHI list (unless you wish to be, or have a personal sensitivity or allergy to nuts). But saying that, certain nuts are OK, and others are best restricted.
Nuts scoring a 0 include pistachios, brazil nuts and macadamia. Almonds score a 1 and I have read elsewhere that pecans are OK in small quantities (for some reason they are not mentioned on SIGHI). Other nuts such as peanuts score 3 and so are probably best avoided.
The SIGHI list and gluten
Eating low histamine doesn’t mean you need to be gluten-free (unless you are also coeliac or have been advised to be GF by a doctor). Saying that, I know a lot of people prefer to avoid gluten if they have MCAS, particularly if they have other conditions where gluten can be an issue for them.
Wheat itself scores 1 on SIGHI, so it would depend upon your level of sensitivity to it as to whether you would eat regular bread, pasta, cous cous etc or not (be careful about any additional ingredients). Rye and barley also score 1, but wheatgerm is higher histamine scoring a 2.
The SIGHI list and cheese
I am a cheese-aholic. Honestly, it’s my favourite food without a doubt. I’ll start with the good news – most fresh, young cheese are fine in line with the SIGHI food list. I’m talking mozzarella, ricotta, cream cheese, mascarpone and young Gouda cheese.
The more annoying news is that most hard, aged cheeses are suggested to be restricted due to their high histamine content. So unfortunately there has been no gooey, smelly blue cheeses or camembert for me for several years.
Starting out on a low histamine diet
I have a longer post – 10 tips for starting a low histamine diet – that you may find helpful if you are new to this diet. Essentially though, I would begin by working out all the foods that you can eat. Write them down if need be, so you have a positive list of ‘allowed’ foods. Then work out some meals that you can put together with those ingredients. Focus on starches, meat, fish or dairy and then add the fruit and vegetables. Try not to dwell on the higher histamine foods that are restricted as that can bring on a negative mindset.
Once you have your ‘allowed’ list, have a think about whether any of your favourite meals can be put together with a few alterations. My easy low histamine food swaps post may be helpful here. For example, swap types of cheese, replace tomatoes with roasted peppers, and coconut milk for sour cream or similar. The taste may not be identical, but it may even taste better with a few swaps here and there!
Following the SIGHI list as a vegan
It is possible to eat low histamine vegan, and I know a couple of people who do. Personally, I tried to eat a low histamine vegan diet as part of Veganuary earlier this year, as I discuss in my post attempting to a low histamine vegan, and found it very challenging. I wasn’t getting enough protein and after just a few days I was really hungry and bored of eating the same foods over and over again.
The trouble is, vegan protein sources on a low histamine diet are fairly minimal – some nuts and seeds, quinoa and protein powders if you can find one that suits you. Other typical plant-based protein sources such as beans, lentils, soy and tofu are high histamine (they mostly score 2). While SIGHI doesn’t mention tempeh or seitan, the fact that they are very processed would likely mean that they have a higher histamine content. If you are thinking of being low histamine vegan I would suggest seeing a dietician to make sure you are getting all the nutrition and vitamins that you need to be as healthy as possible.
Saying that, I know other people are vegan on a low histamine diet and it works well for them.
Do you take supplements to help with MCAS?
Every person is different, so follow the advice of your doctor as to any supplements that you take. It is important to check with them first in case there are reasons you should not take a supplement, such as whether it may be problematic due to a medical condition you have or it should not be taken with other medications you also take.
Personally, I take prescribed medications and some supplements. My supplements are:
Quercetin – this flavanoid is a mast cell stabiliser. My doctor recommended that I take quercetin and I have seen a positive improvement in my MCAS symptoms since taking it. I use Solgar quercetin as it is a reputable brand and came recommended by my doctor and others in the MCAS community. I take one tablet in the morning with breakfast, and another with my evening meal. If you would like more information on quercetin, then I pulled together some research on it in this post. Some people shouldn't take quercetin however, so check with your doctor.
Vitamin C – also understood to be helpful for histamine issues, I take around 1000mg a day and up the dose a little when my symptoms flare. Solgar vitamin C is my go-to brand.
Vitamin D3 – not taken specifically for MCAS issues, but every doctor I see recommends it to me due to living in the Northern Hemisphere where deficiency is common. I was deficient for years until I started to regularly use the BetterYou vitamin D spray (so much easier than tablets and great if you have issues with malabsorption or swallowing issues). Tablets just didn't seem to work for me, but this definitely does!
Gentle iron - again, not specifically for MCAS but I know many of us are deficient. I found regular iron tablets really difficult to take, and had some rather unwanted side-effects from them . . . The Solgar gentle iron is exactly as it sounds - gentle on the stomach and I don't have any issues with it. So glad a dietician suggested it to me!
How do you ‘score’ ingredients on your low histamine recipes?
All recipes on my blog give the ‘score’ of histamine for the ingredients if they are whole foods – so fruit, vegetables, fish, starches etc. If the product is a branded processed product such as vegetable stock I can’t give a score as SIGHI doesn’t provide that information, and of course all brands use different ingredients in their products.
It is worth noting that some foods such as cream cheese will score as a 0 on SIGHI, but you should have a check of the ingredients of the brand you buy as they may contain additives or preservatives you may wish to avoid.
Books and websites on MCAS
For MCAS I would recommend the website Mast Cell Action – really comprehensive with lots of info.
In terms of books, the best I have found is Never bet against Occam: mast cell activation disease and the epidemics of chronic illness and medical complexity by a leading MCAS doctor, Dr Lawrence Afrin. It is huge and packed with a lot of information as well as patient stories, which gives it a more ‘human’ perspective.
Also great is Amber Walker's Mast Cells United. This book is really good for its holistic approach, giving more 'medical' info as well as conventional and natural treatment options as well as dietary considerations and holistic healing approaches.
Low histamine cookbooks
Other than my own recipes (shameless plug there!), there are a few books offering low histamine recipes. The SIGHI book mentioned below obviously follows their food compatibility list for histamine, but the others follow various other food lists which differ in the foods considered high and low histamine, so be aware of your own personal sensitivities or allergies.
Michelle Berriedale-Johnson; Histamine intolerance the cookbook: delicious recipes for people on low histamine diets
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Please follow the advice of your doctor as to all medical treatments, supplements, and dietary choices, as set out in my disclaimer. I am not a medical professional, and all posts on this blog are for informational purposes only.