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Practical Guide to the Low Histamine Diet

• Step 2 (two weeks): Eat your regular diet, but


follow “Minimize Histamine Formation during
Food Storage.” After two weeks, if these chang-
es have not helped, you do not need to contin-
ue with them. Leftovers are not a concern for
you!
• Step 3 (two weeks): Restrict fermented foods –
such as aged cheese, yogurt, kefir, kombucha,
kimchi, sauerkraut, tempeh, natto, aged sau-
sage, etc.
If you think a low histamine diet may help, it is
• Step 4 (three weeks): Follow the full low hista-
important to try it systematically. Many people
mine diet – either my version (Wendy’s Low
follow a low histamine diet, on-and-off, without
Histamine Diet Guidelines) or a different one.
really knowing if it is helping. A systematic trial
Change your diet gradually over a few weeks.
will help you decide if the diet is helping. Here are
For most people, sudden dietary changes are
a few things to keep in mind.
hard on the body. Note: if any of the above re-
• The low histamine diet is a guideline based on an strictions were not helpful, follow the low hista-
educated guess, not a precise diet based on fact. mine diet guidelines, but ignore that restriction.
Please read Histamine Intolerance for a further For example, if minimizing histamine formation
discussion. was not helpful, follow the low histamine diet,
• The low histamine diet should be the only but don’t worry about leftovers.
change. For example, if you start a low histamine
diet at the same time as new medications, and Minimize Histamine Formation During Food Storage
feel better, you would not know which change As food spoilage bacteria grow in food, they produce
was responsible for the improvement. histamine (and other diamines). Therefore, an im-
• Eating a healthy diet is just as important as fol- portant part of the low histamine diet is to eat fresh
lowing the restriction. Consider booking an ap- food. Clients often ask – how long can food be in the
pointment with a registered dietitian to ensure fridge, etc. Unfortunately, there are not exact guide-
you are eating nutritiously during your restricted lines. In summary, you need to follow the typical food
diet trial. safety guidelines for preventing food poisoning, but
• The low histamine diet encompasses a few much more strictly .
different theories, and it is good to test these Typical food safety guidelines suggest discarding food if
parts separately. Ideally, you should not restrict it has been in the Danger Zone (4 – 600 C or 40 - 1400 F)
your diet anymore that necessary. If your symp- for more than two hours or in the refrigerator for more
toms improve at any stage, continue with the
than 4 days. Bacteria grow rapidly in the danger zone
restriction and add the next restrictions to see if
and more slowly in the fridge.
you experience further benefit. If a restriction is
not helpful, discontinue it, but try the next re-
striction.
General Tips:
• Step 1 (one week): Cut out alcohol, be-
cause it is the most common symptom • Don’t worry about food that is low risk for food poi-
trigger. soning, such as food that can sit at room temperature
(e.g., chips, cereal, crackers) or food that can sit in

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This is general information and should not replace the advice of your health care professional. Wendy Busse is not liable in any way for actions
based on the use of this information. This handout may be reproduced without permission for education purposes. This handout may not be
changed without written permission from Wendy Busse.
the fridge for extended periods of time (e.g., These batches probably had more bacteria when pur-
mustard, jam, etc.) chased and were, therefore, more susceptible to his-
tamine/diamine formation.
• Clients report that fruit and vegetables are more
problematic as they over ripen. Histamine possi- • Raw meat:
bly increases (but this has never been tested, so • Raw meat has a lot of bacteria which can grow
it is only an educated guess). It is best to eat as very quickly, so it is very susceptible to histamine/
fresh as possible by: diamine formation. In summary, keep the raw
• Buy small quantities and shop frequently meat out of the Danger Zone (4 – 600C or 40 -
1400F). Cook it or freeze it as soon as possible.
• Keep your produce in something designed
to maintain quality (e.g., produce bags • Ideally, purchase meat that has been butchered
with a paper towel, specialized container, and frozen very quickly. Ask if each piece can be
etc.) frozen individually.
• When your fruit is at its peak freshness • If you purchase fresh meat, make sure it has not
and just about to decline, chop it up and been sitting very long. Pick it up from the store
freeze to use in smoothies. soon after it has been delivered (most butchers
can tell you this will be, but call ahead to make
• Freeze individual meals. Rather than cooking for
sure it has been delivered).
each meal, you just need to reheat.
• Pick up your meat at the end of grocery shopping,
• Shed cheese and freeze in small containers.
and keep it cool in an insulated bag. If it is fresh,
• Be very careful not to contaminate yogurt, sour add an ice pack or something else that is frozen.
cream, cream cheese, etc. Use a clean utensil to
• Avoid ground meat/chicken, unless it has been
take out what you need and put it immediately
ground and frozen quickly. A piece of meat has
back in the fridge. Don’t keep these products
bacteria on the outside, but grinding spreads the
more than three days.
bacteria throughout the entire batch. That’s why
• Vacuum sealing should help – because it re- the public health department recommends cook-
moves oxygen. However, for the two week trial, ing hamburger until the middle is well done, but is
it is best to freeze foods instead. If you are going less concerned about rare steak. Bacteria and his-
to continue to avoid leftovers, you can experi- tamine can develop much more quickly in ground
ment with vacuum sealing. meat.
Meat-Specific Tips: • Avoid mechanically tenderized meat. Tough meat
• The tips below refer to “meat,” but they also ap- is broken down by poking it with small blades,
ply to any animal or fish. which introduces bacteria into the inside.
• High protein foods are thought to be more sus- • Some internet websites suggest avoiding hung
ceptible to histamine formation because the (e.g., beef). However, federally inspected plants
precursor of histamine is histidine (an amino ac- hang meat at about 20C (350F) which is just above
id which is the building blocks of protein). There- freezing, so very little bacteria should grow. In
fore, take extra precautions with meat. some parts of the world, meat is hung at room
temperature (and you want to avoid this meat).
• Some clients experience inconsistent reactions
to meat. For example, one client tolerated • Fish is low in histamine, but only if was gutted and
ground chicken on most occasions but experi- cooled quickly. Most commercial companies, gut
enced a reaction with about 1 in 10 batches. and flash freeze fish right on the ship.

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• Try cooking your meat as soon as you get
home and then freezing it in individual por-
tions. Steaming is a great way to reheat the
meat, without drying it out.
• You can also steam the frozen meat. After it has
thawed and cooked, you can brown it. For exam-
ple, put some water and a steamer basket in a
large fry pan. Steam the meat until cooked
through the middle, cool and dry the frying pan,
heat some oil and brown the meat.
• Ideally, thaw meat in the fridge, but another op-
tion for thin cuts of meat is to put it in a water-
proof, sealed baggie and submerge in cool wa-
ter. Keep checking it. Remove it promptly.
• Slow cooking meat is not recommended on the
low histamine diet, because the meat may sit in
the Danger Zone for an extended period. Pres-
sure cooking is a better option. If you decide to
slow cook:
• Heat the slower cooker before adding the
food. Keep it on high (above 600C (1400F)
for the entire time.
• Heat the liquid (ideally boiling) before
pouring in the hot slow cooker and then
add the meat/chicken immediately after.
• Smaller pieces will cook faster than larger
ones.
• Use fresh or thawed, not frozen.

• Brown the outside of the meat/chicken,


before putting it in the slow cooker.

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Wendy’s Low Histamine Diet Guidelines
The diet guidelines below are less restrictive than most low histamine diets on the internet. Everyone has
their unique sensitivities, so this is not the “right diet,” but it can be a good place to start.
There is not enough definitive information to indicate “allowed” and “restricted.” Therefore, I’ve used
“usually do not increase symptoms” and “commonly reported to increase symptoms.” You must use your
judgement. Everyone has individual tolerances! I’ve differentiated between food that is restricted because
it is reported to be histamine-releasing and foods that may be high in histamine/diamines. However, this is
an educated guess.
Foods that may be high in histamine/diamines Foods that may release histamine

Foods that usually do not in- Foods that are commonly reported to in-
crease symptoms crease symptoms
Milk Products
Fluid milk Unflavored milk (any fat level) Flavored milk (e.g., chocolate)
Unflavored lactose reduced milk Buttermilk
Cheese Unripened cheese, such as cottage Ripened cheese (all those not listed)
cheese, ricotta, cream cheese, mozza- “Aged” cheese can have very high levels.
rella (histamine may form while
sitting in the fridge, so they should be
vacuum sealed).
Other Other fermented milk products
Yogurt
Kefir
Sour cream
Grains Products
Whole Kernel All (consume the majority of your grain None
Grains products as whole kernel grains. This
provides the best nutrition).
Rice, quinoa, wheat/spelt, barley, oats,
etc.
Bread, crackers Whole grain crackers Many lists include bread as a high histamine food, proba-
Muffin or loaf (unless there are restrict- bly because the dough is fermentation with yeast. Other
ed ingredients) fermented foods (such as cheese, sausage, and wine)
contain high levels of histamine, so it is possible that
bread does as well.
Cereals Hot plain whole grain cereals
Cold Cereals based on whole grains
Cookies, cake Moderation for good health Chocolate chips and chocolate icing
Pasta, Noodles All
Other Popcorn

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Foods that usually do not in- Foods that are commonly reported to in-
crease symptoms crease symptoms
Vegetables All other vegetables Tomato and tomato products
Eggplant
Pumpkin
Sauerkraut
Spinach
Avocado

Sauerkraut (fermented cabbage) or kimchi (oriental fer-


mented vegetables)
Overripe Vegetables
Fruit All others Strawberries and raspberries
Many low histamine websites have a Citrus fruit (lemon, lime, orange, and grapefruit) Note: a
long list of fruit to avoid. However, small amount of lemon or lime as a flavor enhancer is
the restricted fruit varies between okay.
lists. Fruit is nutritious, but limit to Pineapple
one serving (about ½ cup) per meal. Overripe Fruit
Dried fruit (you can purchase dried Excess dried fruit
fruit that is not sulfited, or you can
dry your own). Limit dried fruit to
about one tablespoon per serving.
Many clients tolerate very fresh fruit
and vegetables the best (when fruit
starts to over-ripen, slice it, freeze
and then use in smoothies).
High Protein Foods
Meat and Poultry Fresh meat or poultry (see special care Processed meat products: luncheon meat, wieners,
for meat) sausages
Fish/Seafood Fresh fish (i.e., caught and cooked or Smoked fish
frozen quickly). Canned tuna
Fish or seafood that has not been frozen
Eggs Egg yolks are said to be okay, but it is Egg White
tedious to separate eggs. (Note: In my experience, most clients tolerate eggs, and
they are a good source of protein. If you feel eggs are
okay for you, limit eggs to less than one per day during
the elimination diet trial).
Legumes Dried beans and peas (black beans, Soy beans (e.g., edamame beans, tofu, many vegetarian
chick peas, kidney beans) products).
Lentils
Nuts All others Walnuts (the www.histaminintoleranz.ch list restricts all
nuts and then says some are okay. It’s not clear. They list
walnuts as the worse)
Seeds Hemp Seeds Pumpkin seeds (restricted on Dr. Janice Joneja’s list)
Flax Seeds Sunflower seeds (restricted on www.histaminintoleranz.ch
Chia Seeds list)

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Foods that usually do not in- Foods that are commonly reported to in-
crease symptoms crease symptoms
Condiments
Spices & Herbs All others Cinnamon, cloves, curry powder, chili powder, nutmeg,
anise, thyme (these spices are said to be high in salicy-
lates and natural benzoates which are claimed to cause a
histamine release)
Fats & Oils Vegetable oil (coconut oil, olive oil, Man-made fats (e.g., trans fats) promote inflammation in
canola oil) the body. Avoid margarine and vegetable oil shortening.
Butter
Sweeteners Sugar (moderation for good health) None
Honey
Stevia
Other Plain vinegar Aged vinegar, such as balsamic
Mustard Ketchup
Mayonnaise (It is restricted on many Fermented soy (e.g., soy sauce, miso)
diets because it contains vinegar and
egg white. However, most people
tolerate it.)
Beverages
Alcohol None All
Coffee/Tea Coffee (less than 3 cups/day, as it both- Black and green tea
ers some people’s digestion)
Weak herbal teas
Other Hot chocolate
Orange Juice
Tomato Juice
Miscellaneous
Soup Base Yeast –free soup base Soup base with yeast
(although many have curry or turmeric,
which is the main ingredient in curry)

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Common Questions is not leftovers and is not an overripe fruit or vegeta-
ble), it will likely be low in histamine.
The most common questions that clients ask
about the low histamine diet are listed below. What if I still have symptoms on the low histamine
diet?
Will a low histamine diet help me?
Puzzling food allergy symptoms are often related to
Currently, there are no reliable tests to determine several, cumulative triggers (diet and no-diet triggers).
if a person has histamine intolerance. The only Changing your diet may reduce, but usually does not
way to know is to follow a low histamine diet and eliminate symptoms. This does not mean the low hista-
observe symptoms. mine diet is ineffective. The question is: Are your
Histamine intolerance symptoms could apply to symptoms better on the diet?
many other inflammatory conditions as well (e.g., Should I try other food restrictions at the same time?
seasonal allergies). If you experience these symp-
toms, it does not mean that you have histamine It is best to make only one dietary change at a time.
intolerance and must follow a low histamine diet. For example, if you start a low histamine and a gluten-
However, it is worth trying a low histamine diet free diet at the same time, and you feel better, you
and continuing with it, only if you experience sig- won’t know which restriction was helpful.
nificant improvement. What about very small quantities?
Before starting the diet, you must consider the Very small quantities of a “food commonly reported to
disadvantages. Dietary changes can be time con- increase symptoms” is usually okay for most clients.
suming and stressful.
Is there a “histamine-free” diet?
How long should I follow a low histamine diet?
Clients often want a “histamine-free” diet for two rea-
If you feel better on a low histamine diet, follow it sons. Firstly, some clients feel better on a low hista-
for about four weeks before increasing dietary mine diet, but not completely. They would like to elim-
histamine. inate additional food to improve symptoms even more.
If you don’t feel better, a three-week trial is suffi- However, many non-diet factors contribute to symp-
cient. If the diet is going to help, you will know by toms and symptoms will still occur, no matter what
then. they eat. Secondly, some clients request a “histamine-
free diet” because they are scared about a very severe
What is the difference between histamine intol- reaction.
erance and mast cell activation syndrome?
A “histamine-free” diet is not possible because the diet
If the “histamine- releasing foods” theory is cor- is primarily based on an educated guess and anecdotal
rect, this would mean that that food can directly reports of problematic foods. If you restricted every
cause mast cells to release histamine (i.e., food food that is suggested to cause a problem on the inter-
dependent, non-allergic mast cell activation). net, there would not be anything left to eat! Over re-
These are both theories, so it is hard to make a striction leads to stress and malnutrition, further com-
definitive statement. The good news is that the promising health.
dietary approach to improving the symptoms is
the same, regardless of what you call it.
What about food that is not on the guidelines
above?
If the food is not fermented and is very fresh (e.g.,

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Meal Plan Ideas
The following meal ideas are based on Wendy’s Low Histamine Diet Guidelines (see above). Individual toler-
ances vary, so you will likely need to make substitutions. A balanced meal contains protein, whole grain or
starchy vegetable, fruit or vegetable and some fat. An additional source of calcium and vitamin D may be
needed. A registered dietitian can work with you to plan a nutritious menu.
Protein Whole Grain or Starchy Vege- Fruit or Vegetable Fat (if needed, beyond other
table foods)
Breakfast *Note: soy beverage is the only milk substitute with equivalent protein and fat to milk.
Milk or hemp seed* Hot oatmeal (cooked in water), Blueberries Provided in milk or hemp seed.

Boiled egg (limit eggs to less Whole grain cracker Sliced apple Butter or coconut oil
than one per day during your
restriction trial, after that you
can experiment)
Peanut or almond butter Muffin or loaf slice Sliced bananas on top (choose Provided in the nut butter
a very fresh banana)
Cottage cheese Brown rice cakes Mango Provided in the cottage cheese
Milk or chopped nuts Cold cereal Diced fruit Provided in the milk or nuts
Chopped nuts or seeds Whole grain pancakes Fruit syrup (puree fruit such as Butter or coconut oil
mango and add a little sweet-
ener, if needed)
Hot Meals
Baked chicken browned in oil Baked potato (bake a few extra Steamed green beans and Provided in the chicken and oil
to fry the next day) chopped green onions
Hearty soup (freeze in individ- Whole grain crackers Vegetables in the soup Sauté the vegetables in oil, be-
ual portions to reheat on busy fore simmering.
days)
Kebab: chicken cooked on the Brown rice Bell pepper and zucchini –1- Provided in the chicken/oil. Add
grill or baked in the oven. inch chunks *brushed with oil vegetable oil to the rice, if you
need extra fat.
Sautéed chicken strips Whole grain wrap Sautéed sweet bell peppers- From the oil
Fruit salsa
Bean dip Whole grain wrap Grated carrots Add oil to bean dip

Portable Meals High protein food should be kept cold. If food cannot be refrigerated, use an insulated container with an ice pack.
Sliced mozzarella cheese Whole grain crackers Carrot sticks Provided in the cheese
Bean dip Corn chips Celery sticks Add vegetable oil to the bean dip

Hemp seeds Whole grain tortilla Shredded carrots Cream cheese


Trail Mix: almonds or other Cold cereal or home popped Dried fruit (dry your own or Provided in the nuts/seeds
nuts or seeds popcorn purchase non-sulphited). Limit
to 1 tablespoon per serving.
Nut butter Cold pancake Thinly sliced apples Provided in the nuts
Snacks
Home-made popcorn on the stove in coconut oil
Cream cheese on whole grain crackers
Celery stick filled with peanut or almond butter and a few sulfite-free raisins (Ants on a log!)
Crispy chick peas

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