Do you experience skin rash, sinus congestion, migraines, fatigue or gut upset, especially after eating? If so, you might have Histamine Sensitivity. These symptoms are often mistaken for an allergic reaction or even IBS (Irritable Bowel Syndrome). In reality, they may just be your body reacting to an oversupply of histamine.
Histamines are a chemical that your immune system makes as part of your body’s immune response. This is typically in response to things like pollen, dust or pet hair. Your body’s intention is to keep you safe, but an overreaction can make you feel a variety of symptoms. These symptoms include sinus congestion, hives, bloating, constipation, diarrhea, brain fog, migraines and fatigue.
|Digestive||Airway||Skin||Central Nervous System|
|Constipation||Sinus congestion||Rash||Headaches & migraines|
|Diarrhea||Post nasal drip||Hives||Vertigo|
|Bloating and gas||Asthma / wheezing||Angioedema (swelling)||Regulation of body temperature|
|Reflux||Chronic cough||Urticaria (itching)||Poor concentration|
|Nausea||Irritability and restlessness|
|Mouth ulcers||Anxiety and depression|
A low histamine diet limits histamine-containing and histamine-liberating foods for a period of time. The goal is to see if you feel better. If you do, the diet is followed by a gradual reintroduction to identify your personal tolerances and thresholds. There are many resources for this on the internet or that can be provided by your dietitian. The most-well known food chemical diet is the SIGHI diet. Given that there is a lot of outdated information over the internet, it is important that you follow evidence-based resources that are updated regularly.
Histamine is not the only type of food chemical. In fact, there are many other types of chemicals that can trigger reactions in sensitive people. These include:
At Everyday Nutrition, we prefer to use the Royal Prince Alfred Hospital (RPAH) diet for assessing food chemical sensitivity. The RPAH diet checks for sensitivity not only to histamine but to other amines, salicylates, glutamates and additives as well. For example, it’s not uncommon for someone to be sensitive to histamine containing foods but not histamine liberators and vice versa. In this case, the RPAH diet allows us to only limit what you are sensitive to and not over restrict unnecessarily.
There are three phases of a food chemical elimination diet. The process begins with an Elimination Phase where the person removes all food chemicals from their diet for a period of 2 to 6 weeks. If a person is in fact sensitive to food chemicals, their symptoms would improve in this phase of the diet. Be aware that during the first 1-2 weeks on the elimination diet, about 50% of people who are histamine sensitive will experience “withdrawal” symptoms. This can make you feel lousy for a few days but is a sign you are on the right path. Push through the symptoms and they will settle.
The second phase of the diet focuses on identifying which chemicals a person is reactive to by reintroducing them, one category at a time, in a structured and methodical process. This allows you to identify which molecules make you feel unwell and which ones have minimal or no effect.
The third phase of the diet is a maintenance phase. In this phase, you limit the chemicals that make you feel poorly and resume eating the other types of chemicals. It’s important to know that although food chemicals can make you feel lousy, they do not cause permanent harm or damage to your body. It’s perfectly OK if you occasionally choose to eat something you know you are sensitive to and just live with the symptoms.
When it comes to food chemicals and histamines, there is a lot of conflicting information online. Information may also be outdated or not suited to a person’s particular needs. It is always important to receive and utilize information provided to you by your dietitian or from the Royal Prince Alfred Hospital.
Some of the things your dietitian might consider when deciding if this diet is appropriate for you are if:
Seeing a dietitian is always key to assisting you with the direction of elimination you need to follow. Specialist dietitians are also very experienced in identifying common patterns in your symptoms and food intake. They can use this information to guide the direction to take with diet.
Diet is often seen as a natural and safe method to manage symptoms; however, it doesn’t come without risks and disadvantages. A low chemical or low histamine diet is complex and restrictive. It can be difficult to manage without leading to deficiencies or malnutrition. If you are already underweight or struggling to maintain weight, it may not be sensible.
Additionally, if you have had struggles in the past with your relationship with food or even disordered eating behaviors, you may opt to try other approaches before restricting your diet.
If your symptoms and trigger foods clearly warrant a different approach (e.g., a Low FODMAP diet), you may want to try that first.
Finally, it may just not be the right time for any number of reasons, and that’s ok. Getting the timing right is important. You can always explore other options and come back to the diet in the future. You need to be in the right head space to give it a try. Your dietitian will help guide you towards the most appropriate option based on your situation.
There is most definitely cross over between food chemical sensitivity, histamine intolerance and MCAS. Certainly, some people with MCAS benefit from a low chemical or low amine diet. In this situation, it is usually not diet alone that is the answer. If this is you, we suggest seeing a specialist dietitian to assess which approach is best for your needs.
|Salicylates (histamine liberators)||Fruits, vegetables, herbs, spices, tea, coffee, wine, juice, nuts and aspirin|
|Amines (Histamine containing)||Aged meat, fish and cheese, over-ripe bananas, avocados, tomatoes, red wine, beer and chocolate|
|Glutamates (Histamine containing)||Tomatoes, grapes, mushrooms, cheese, and wine|
|Glutamates/flavour enhancers||MSG found in Chinese food and savory snacks|
|Sulphites||Dried fruit, juice, cordial, soft drinks, wine and sausages|
|Propionates||Bread and bakery products|
|Sorbates||Juices, soft drinks, dairy products, dips, dried fruit, bread and bakery products|
|Benzoates||Juices, sports drinks, soft drinks and dips|
|Nitrates||Preserved meats such as ham, salami and bacon|
|Anti-oxidants||Savory snacks, crackers and oils|
|Artificial colours & Annatto||Confectionary, juice, soft drinks, cakes, yogurts and ice creams|
Keep in mind that research into food chemicals is limited. Additionally, reactions to histamines are quite nuanced from person to person.
You may come across foods or ingredients that are not tested or do not have any data. In this case, we recommend avoiding these during the elimination period. You can test your personal tolerance to them once you get to the maintenance phase to determine your individual sensitivity.
Unfortunately, it’s not well understood how histamine and food chemicals cause symptoms. It is thought that some people metabolize histamines faster and others metabolize them slower. If you are a slow metabolizer, you may end up with a build-up of histamine in your system over a few meals or days. This leads to higher overall levels than someone who is a fast metabolizer.
Another consideration is to look at the enzyme that metabolizes ingested histamine called Diamine Oxidase (DAO). Alcohol can block DAO and diminish your ability to metabolize ingested histamine.
It is important to note that stress or high levels of cortisol can make you more sensitive. For this reason, including stress management techniques such as mindfulness is always a good idea.
To get a list of foods high in histamine and other food chemicals, visit these resources:
In summary, consider a food chemical sensitivity if you cannot find a medical reason for your symptoms. It may be worth exploring a low chemical diet or histamine diet with your dietitian. Identifying and removing your triggers can dramatically improve your symptoms and increase your quality of life. As always, it’s best to work with a dietitian.
Liz Radicevic is an Accredited Practising Dietitian (APD) based out of Melbourne, Australia. She specializes in food sensitivity and gut issues such as Celiac and IBS including FODMAPs and food chemical sensitivity. Liz loves helping people to become the best version of themselves without unnecessary restriction. She knows what it’s like to live with IBS and wants you to know that you’re not alone.