Practical Guide to the Low Histamine Diet

Step 4 (three weeks): Follow the full low histamine diet

– either my version (Wendy’s Low Histamine Diet
Guidelines) or a different one. Change your diet gradu-
ally over a few weeks. Sudden dietary changes are hard
on the body.
Note: if a step is not helpful, continue to the next step,
but include that step in your diet. For example, if step
#2 - minimize histamine formation was not helpful, you
can eat leftovers during step 3 and 4.

Minimize Histamine Formation

The low histamine diet is a guideline based on an
educated guess, not precise rules. During Food Storage
Follow these guidelines strictly during your two-week
Many people follow a low histamine diet, on-and- trial. If it helps and you are planning to continue, ex-
off, without really knowing if it is helping. A sys- periment to see where you can ease up.
tematic trial will help you determine it is benefi-
cial. Food spoilage bacteria produce histamine (and other
diamines). Readers often ask – how long can food be in
The low histamine diet should be your only the fridge, etc. Unfortunately, there is not an exact
change. If you start a low histamine diet and new guideline. In summary, you need to follow the typical
medications at the same time, and you feel better, food safety guidelines for preventing food poisoning,
you would not know which change was responsi- but more strictly.
ble for the improvement.
Danger zone
Eating a healthy diet is just as important as follow-
ing the restriction. Consider booking an appoint- Typical food safety guidelines suggest discarding food if
it has been in the Danger Zone (4 – 600 C or 40 - 1400 F)
ment with a registered dietitian to ensure you are for more than two hours or in the refrigerator for more
eating nutritiously during your restricted diet trial. than 4 days. Bacteria grow rapidly in the danger zone
and more slowly in the fridge.
The low histamine diet encompasses a few differ-
ent theories, and it is helpful to test these theo-
ries separately. This approach will ensure you General Tips:
don’t follow unnecessary restrictions.
Don’t worry about food that is low risk for spoilage,
Step 1 (one week): Cut out alcohol, because it is
such as food that can sit at room temperature (e.g.,
the most common symptom trigger.
chips, cereal, crackers) or food that can sit in the fridge
Step 2 (two weeks): Eat your regular diet but fol- for extended periods (e.g., mustard, jam, etc.)
low “Minimize Histamine Formation during Food
Fruit and vegetables are often more problematic when
Storage.” After two weeks, if these changes have
they over-ripen. Histamine possibly increases (but this
not helped, leftovers are not a concern for you!
has never been tested, so it is only an educated guess).
Step 3 (two weeks): Restrict fermented foods – It is best to eat as fresh as possible:
such as aged cheese, yogurt, kefir, kombucha,
• Buy small quantities and shop frequently
kimchi, sauerkraut, tempeh, natto, aged sausage,
etc. • Keep your produce in something designed to

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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.
 maintain quality (e.g., produce bags with a meat has bacteria on the outside, but grinding
paper towel, specialized container, etc.) spreads the bacteria throughout the entire
batch. Bacteria multiply quickly in ground meat.
• When your fruit is at its peak freshness and
just about to decline, dice it and freeze to • Avoid mechanically tenderized meat. Meat is
use in smoothies. poked with small blades to break down the tough
fibers, but this contaminates the inside of the
Freeze individual meals and reheat them right be-
meat.
fore eating. You’ll spend a lot less time cooking
and doing dishes. • Some internet websites suggest avoiding hung
meat (e.g., beef). However, federally inspected
Be very careful not to contaminate food in your
plants hang meat at about 20 C (350F) which is
refrigerator. Use a clean utensil to take out what
just above freezing so very little bacteria would
you need and put the food back in the fridge
quickly. grow. In some parts of the world, meat hangs at
room temperature (avoid this meat).
Vacuum sealing removes oxygen and reduces bac-
• Fish that is gutted and cooled (or frozen) quickly
teria growth. However, for the two-week trial, it is
would not be high in histamine. Most commer-
best to prepare fresh meals or freeze meals. If you
cial companies, gut and flash freeze fish right on
continue past the trial, experiment with vacuum
the ship.
sealing.

Purchasing Raw Meat Cooking Meat

When you get home from the grocery store, freeze
The tips below refer to “meat,” but they also ap-
your raw meat or cook it. Don’t let raw meat sit on the
ply to any animal or fish.
counter (or more than three hours in the fridge).
High protein foods are probably more susceptible
Thaw frozen meat quickly by:
to histamine formation because they are high in
histidine (the precursor of histamine). Therefore, • microwaving on low power
take extra precautions with meat, especially raw • put thin cuts of meat it in a waterproof, sealed
meat (because it is very high in bacteria). baggie and submerge in cool water. Keep check-
• Raw meat is highly contaminated, and bac- ing and cook as soon as it is thawed
teria grow very quickly if the meat is in the • place frozen meat in a steamer basket in a pot.
Danger Zone (see above). Add water, bring to a boil and then simmer. The
• Ideally, purchase meat that has been butch- level of water should be below the meat (even
ered and frozen quickly. when it is simmering). After thawing, you can
continue cooking in the steamer basket or cook
• If you purchase fresh meat, make sure it has
with a different method (e.g. pan fried).
not been sitting for very long. Pick it up from
the store soon after it has been delivered You can freeze cooked meat, but it can be a little dry
(call ahead and talk to the butcher). when you reheat. However, it works well to slice it and
use in salads, wraps, etc.
• Pick up your meat at the end of grocery
shopping, and keep it cool in an insulated Slow cooking meat is not recommended on the low
bag. If it is fresh, add an ice pack. histamine diet, because the meat may sit in the Danger
Zone for an extended period. Pressure cooking is a
• Avoid ground meat/chicken, unless it has
better option. If you decide to slow cook:
been ground and frozen quickly. A chunk of

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 • Heat the slower cooker before adding the
food. Keep it on high.
• Heat the liquid (ideally boiling) before pour-
ing 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, be-
fore putting it in the slow cooker.
Marinating is potentially problematic because the
meat sits in the fridge for several hours. Using a
rub on the surface of the meat is a better choice
during the two-week trial (salt and pepper even
work). Once the two-week trial is over and if you
decide to continue with the guidelines, experi-
ment with marinating in a vacuum sealed contain-
er in the fridge.

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 Wendy’s Low Histamine Diet Guidelines
If you want to print these guidelines, use the download link at the top of the page.
My diet guidelines are less restrictive than most low histamine diets on the internet. The low histamine diet
is an “educated guess, so this is not the “right diet.”
There is not enough definitive information to indicate “allowed” and “restricted.” Therefore, I’ve used
“usually does not increase symptoms” and “commonly reported to increase symptoms.” Use your judge-
ment. Everyone has individual tolerances!

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 not eliminate symptoms. However, this does not mean
the low histamine diet is ineffective. The question is:
Are your symptoms better on the diet?
Will a low histamine diet help me?
Currently, there are no reliable tests to determine
if a person has histamine intolerance. Systemati- Should I try other food restrictions at the same
cally trialling a low histamine diet is the only way time?
to know. It is best to make only one dietary change at a time.
For example, if you start a low histamine and a gluten-
Many factors (e.g., seasonal allergies) cause hista-
free diet at the same time, and you feel better, you
mine intolerance symptoms. If you experience
won’t know which restriction was helpful.
these symptoms, it does not mean that you have
histamine intolerance and must follow a low his-
tamine diet. However, it is worth trying a low his- What about minute quantities of restricted food?
tamine diet and continuing with it, only if you ex- Minute quantities are okay. You don’t need to worry
perience significant improvement. about cross contamination.
Before starting a low histamine diet trial, consider
the disadvantages. Dietary changes can be time Is there a “histamine-free” diet?
consuming and stressful. Clients often want a “histamine-free” diet for two rea-
sons. Firstly, some clients feel better on a low hista-
How long should I follow a low histamine mine diet, but not completely. They would like to fur-
diet? ther improve symptoms with additional food elimina-
If you feel better on a low histamine diet, follow it tion. However, many non-diet factors contribute to
for about four weeks before starting to liberalize symptoms and symptoms will still occur, no matter
your diet. what they eat. Secondly, some clients want to follow a
“histamine-free diet” because they are scared about
If you don’t feel better, a three-week trial is suffi- severe reactions.
cient. If the diet is going to help, you will know by
then. A “histamine-free” diet is not possible because it is an
educated guess, based on anecdotal reports. If you re-
strict every problematic food on the internet, there
What about food that is not on the guide- wouldn’t be anything left to eat! Over restriction leads
lines above? to stress and malnutrition, further compromising
If the food is not fermented and is fresh (e.g., is health.
not leftovers and is not an overripe fruit or vege-
table), you will probably tolerate it.

What if I still have symptoms on the low his-

tamine diet?
Puzzling food allergy symptoms are often related
to several, cumulative triggers (diet and non-diet).
Changing your diet may reduce, but usually does

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Meal Plan Ideas
I’ve listed some meal plan ideas to help you follow Wendy’s Low Histamine Diet Guidelines. Individual tolerances 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 (i.e. the items in
each row would provide a balanced meal). 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 Vegetable Fruit or Vegetable Fat (if needed, beyond other 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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