Many foods contain histamine, while others can trigger your mast cells to release it directly into your tissues. Read on to learn which foods are high & low in biogenic amines and which might activate mast cells.
What are Biogenic Amines?
Biogenic amines are natural nitrogen-containing compounds often produced in large quantities by bacteria. As such, foods are more likely to contain biogenic amines after fermentation, storage, or decay [1].
These compounds include beta-phenylethylamine, tyramine, tryptamine, putrescine, cadaverine, spermine, and spermidine, but histamine is the most common and the one most frequently linked to food-related symptoms [1].
Many biogenic amines are harmful, while others are beneficial to human health. Spermidine, for example, prolongs the lifespan of several model organisms like yeast, nematodes, and flies. It reduces oxidative stress and helps cells clear waste and recycle useful components [2].
Biogenic amines are commonly found in fish, fish products, meat, dairy products, wine, cider, and beer, as well as spinach, tomatoes, and yeast products [3, 4].
High Histamine Food List
In general, foods likely to contain high levels of biogenic amines are fermented foods or foodstuff exposed to microbial contamination during storage. However, histamine content varies widely, even in foods that usually contain a lot [3, 5].
1) Fermented Foods
Fermentation is a process by which microbes partially digest, chemically alter, and change one food into another: milk into aged cheese, for example, or cabbage into sauerkraut. The microbes responsible for these changes often produce large quantities of histamine, which can spell trouble for someone with histamine intolerance [6, 7].
The main bacteria responsible for biogenic amine production in fermented food are lactic acid bacteria (LAB). These bacteria can break down amino acids into amine-containing compounds. Bacteria produce these compounds as defense mechanisms to withstand acidic environments [3].
Some types of yeast also produce histamine during fermentation. Careful management of yeast during fermentation can drastically change the histamine content of wine [7, 8]. Fermented foods include [7]:
- Sauerkraut and kimchi
- Kombucha, beer & wine
- Pickles
- Tofu, Nattō & other fermented soy products
- Yogurt, buttermilk & kefir
- Cheese (aged cheese tends to contain more histamine than fresh, soft cheese)
- Sausage, pepperoni & salami (and other cured or fermented meats)
Wine
During the winemaking process, yeast and lactic acid bacteria (LAB) produce histamine when they ferment grape must. Management is crucial during this time; the chemical composition of the grape affects the histamine content of the finished wine [8].
According to one study, the average levels of histamine in wine were 3.63 mg/L for French wines, 2.19 mg/L for Italian wines, and 5.02 mg/L for Spanish wines. Generally speaking, red wine has more histamine than white [9, 7].
Some countries place limits for histamine in wine such as Germany (2 mg/L), Holland (3 mg/L), Finland (5 mg/L), Belgium (5 to 6 mg/L), France (8 mg/L), Switzerland, and Austria (10 mg/L). If you are intolerant, but you love red wine, choose wines from countries that place the strictest limits on histamine [3].
2) Canned & Processed Foods
Canned and otherwise processed foods tend to have more histamine than fresh foods. Tomato paste may have as much as 16.6 mg of histamine per 100 g of paste, while canned fish products can have more than 20 mg per 100 g [5, 10].
Even if you are not histamine intolerant, canned fish should be eaten immediately after opening. The longer a can of fish remains open, the more bacteria will grow and produce histamine, increasing the risk of scombroid poisoning [11, 12].
3) Certain Fresh Foods
Most fresh foods, especially fruits and vegetables, are low in histamine. There are exceptions to this rule, however: spinach, eggplant, and tomatoes tend to contain higher amounts. These vegetables may contain enough histamine to trigger an inflammatory response in an intolerant person [7, 13].
Some meats also contain more histamine than others. Pork may be the worst offender. Grilling further increases the histamine levels in meat, while boiling seems to reduce them [11].
4) Chocolate
Cocoa can be relatively high in histamine as well; however, the caffeine and theobromine in cocoa stabilize mast cells, preventing them from releasing histamine into your tissues. It may be appropriate to eliminate chocolate from your diet and reintroduce it later to see how well you tolerate it [14, 15, 16, 17, 18].
Other Histamine-Releasing Foods & Factors
Why do Mast Cells Release Histamine?
Mast cells are the immune cells that produce the most histamine in your body. They release stored histamine in response to a number of triggers, including allergens and infection. For a more complete explanation of mast cells and their mechanisms, see this post on the low histamine diet and how to avoid triggering histamine release.
Foods
Some researchers believe that there are foods that encourage mast cells to release histamine; they call these “histamine liberators.” Citrus fruits seem to be the worst offenders here, though there is some evidence that sulfites in red wine may be troublesome as well [4, 19].
Other possible so-called histamine liberators include [7]:
- Papaya, strawberries & pineapple
- Peanuts & tree nuts
- Tomatoes & spinach, which also contain histamine
- Chocolate; however, chocolate also contains methylxanthines like theobromine, which can stabilize mast cells [20].
- Preserved or canned fish & seafood
- Egg whites
- Pork
- Licorice
- Some spices
- Artificial food additives
Supplements
Some supplements, including probiotics, have been found to trigger the release of histamine from mast cells and basophils. The extent to which these results apply to the human body is unknown, and this may not be an exhaustive list of potentially problematic substances. Talk to your doctor to avoid any adverse events or unexpected reactions.
Probiotics
These bacteria can be beneficial for some people, but they produce enough histamine that may cause trouble for those with histamine intolerance.
- Lactobacillus casei [21]
- Lactobacillus reuteri. Note, however, that not all strains of L. reuteri produce histamine, and many are believed to be anti-inflammatory and anti-allergic [22, 23].
- Lactobacillus delbrueckii ssp. bulgaricus [21]
DAO inhibitors
These compounds prevent diamine oxidase (DAO) from effectively breaking down histamine in animal and cell studies.
- Alcohol. Though not a supplement, many people consume significant enough quantities of alcohol at one time that it may affect histamine metabolism [24].
- Carnosine. This compound, often used as an anti-aging supplement, is made of histidine and beta-alanine. Its close structural relationship with histamine means that it may compete to bind with DAO [25, 26, 27].
- Curcumin. In one study, curcumin inhibited the release of DAO in the intestines of rats; however, it also appeared to prevent mast cells from releasing histamine. According to the authors, the decrease in histamine release may have caused the decrease in DAO release (due to a lower demand for DAO); curcumin’s net effect may still be beneficial [28].
Other
- Supplements that decrease Th1 and increase Th2 may shift the balance of the immune system toward histamine-producing mast cells.
- Nicotine (in cigarette smoke) triggers histamine release from human mast cells [29].
Acute Stress
Additionally, some conditions and events can increase the release of internal histamine in the body. These include [14]:
- Hypoxia (a lack of oxygen)
- Extreme temperatures
- Trauma
Additionally, stress increases histamine reserves in mast cells. Any of the factors listed above can liberate this histamine supply, making for a dangerous combination [30].
Prescription Medication
Unfortunately, some prescription medication can inhibit HMNT and DAO, the enzymes that break down histamine. These drugs can thereby increase histamine levels in the blood and make intolerance symptoms worse [31, 32, 33].
Some people simply cannot avoid these medications; if that’s the case for you, ask your doctor if the substances on our list of natural antihistamines might help you manage these side effects.
The following drugs may increase histamine release or interfere with HNMT and DAO:
- Heparin, an anticoagulant [7]
- Cimetidine, an antacid and H2R blocker; despite being an antihistamine, this drug significantly inhibits DAO [7, 32]
- Chloroquine; this malaria drug’s effect on histamine is considered relatively minor [34]
- Dihydralazine, a drug prescribed for high blood pressure in some countries [7]
- Isoniazid, a tuberculosis drug [35]
- Cefuroxim, an antibiotic [7]
- Cefotiam, an antibiotic [7]
- Chloroquine, an antibiotic [7]
- Aminophylline, an asthma medication [7]
- Verapamil, a calcium channel blocker often prescribed for high blood pressure [7]
- Alprenolol, a beta-blocker often prescribed for high blood pressure [7]
- Dihydralazine, prescribed for high blood pressure [7]
- Opioid analgesics, including morphine and codeine [36, 37]
- Monoamine oxidase inhibitors (MAOIs, the first class of antidepressants) [38]
- Contrast media, given before medical imaging procedures [7]
- Imidazoles, including many fungicides [25, 39]
H. pylori Infection
Helicobacter pylori is a spiral-shaped bacterium that infects about half of all people around the world. Left unchecked, it can cause inflammation, ulcers, and even cancers of the stomach [40].
H. pylori produces lipopolysaccharides (LPS) that stimulate the enterochromaffin-like cells of the stomach to multiply and release histamine. As such, H. pylori infection may increase the quantity of histamine in the gut [41, 42].
Check out our post on H. pylori here.
Low Histamine Food List
Reading through lists of foods, supplements, and lifestyle choices to avoid can be daunting, so let’s take a look at the good stuff next! The foods in this section are low in histamine and shouldn’t encourage your body or gut flora to produce more.
In a study of 22 people with chronic hives, researchers developed an experimental, very low histamine diet that we can use as inspiration. The staple foods for this diet included many of the items in the following list [33].
Grains
- White rice
- Millet
Vegetables
Researchers investigating low-histamine foods recommend eating raw or lightly-cooked vegetables. Fried vegetables are higher in histamine [11].
Fresh Meat & Dairy
- Boiled fresh meat (avoid pork and sausage) [11]
- Boiled fresh fish
- Eggs
- Milk
Note that the foods above may contain small amounts of biogenic amines, including histamine; on the whole, however, eating these foods drastically reduced the quantity of histamine in participants’ diets. Their chronic hives were drastically reduced when eating these foods [33].
The longer a food is stored, the more biogenic amines it contains. This rule applies even to leafy green vegetables, so make sure you buy and eat the freshest possible produce. Don’t let it sit in your fridge or on your countertop [43]!
Personalizing Your Diet
Remember: it’s more important to avoid foods that trigger your symptoms than to follow any one list exactly. Histamine content can vary broadly, even between two different dishes that contain the same food prepared in different ways. Grilled pork, for example, may contain twice as much histamine as boiled pork [11].
If you suspect that a particular food triggers your symptoms, try cutting it out to see if they improve. Then, reintroduce it later to see if those same symptoms return. This is called an elimination diet, and it’s probably the best way to identify your sensitivity triggers [44].
To help combat histamine intolerance, Joe developed the lectin avoidance diet to minimize food sensitivities, along with a cookbook.
More About Histamine
This is the fifth post in a six-part series on histamine, histamine intolerance, and how to manage it. To learn more, click through the links below.
- Part 1: What is Histamine? Definition, Function, Receptors & DAO
- Part 2: 17 Histamine Health Effects: Cognition, Inflammation & Sleep
- Part 3: Histamine Intolerance Symptoms
- Part 4: Low Histamine Diet: Does It Work? + Who Should Try It
- Part 6: Natural Antihistamines to Prevent Histamine Reactions
Takeaway
Foods rich in histamine and other biogenic amines include some fresh foods (spinach, eggplant, and tomatoes), most fermented foods and drinks (beer, sauerkraut, yogurt, sausage, etc.), and many canned or processed foods (fish, tomato paste, etc).
Mast cells may also be triggered by histamine liberators like citrus fruits, sulfites in red wine, and some artificial food additives. Some probiotics, supplements, and prescription medications may also contain, produce, or liberate histamine.
Most fresh meat and produce is low in histamine and should be boiled (not grilled). To avoid biogenic amines in your food, choose only the freshest foods, and store them as briefly as possible. The longer a food is in storage, the more time bacteria have to produce histamine in it.
