Food allergy series: Mast cell food reactions and the low histamine diet

When I started my posts on food allergies, I listed out the causes of food hypersensitivity. Notably absent from this list was mast cell disease. Even among detailed publications on mast cell disease, food reactions are often unmentioned (though potentially subsequent anaphylaxis is usually included.) Unfortunately, food reactions in mast cell disease are still not well understood. Even among experts, the nature and importance of food reactions in overall disease is the subject of much disagreement. Some contend that food reactions are a manifestation of general mast cell reactivity, while some think the foods specifically are sources of reactions. Following this logic, some experts believe in the validity of observing a low histamine diet while others do not.

So please keep in mind that the science behind the low histamine diet is not well accepted or even well defined. I’m going to give you my general comments on the low histamine diet, how I eat and how it has worked for me. It is my personal opinion.

A low histamine diet is one which eliminates or minimizes histamine in the food consumed. I have talked at great length about histamine so I’m not going to reiterate that here. What I will say is that exogenous histamine has been shown to induce mast cell degranulation, which means that histamine from an outside source can cause degranulation. It makes sense to me as a scientist that eating histamine rich foods will cause mast cell degranulation. It especially makes sense because the most commonly problematic food substances for mast cell patients, like alcohol, vinegar and aged cheeses, are major degranulators. I have never been able to tolerate alcohol, so it made sense to me that it was because of degranulation. Again, I prefer to lean on good studies, but in the absence of that, I will accept my own experience living in this body.

Last winter, I was in a lot of pain and generally having a sucky time of life. One of the changes I discussed with my doctors was the low histamine diet. It was in the “this can’t hurt” category. I had put off elimination dieting for a long time due to time and financial constraints, but it seemed like the appropriate time to do it had arrived.

One of the first things that became aware to me was that there is no universally agreed upon low histamine diet. There are lots of websites that discuss it and lay out diet guidelines and none of them are in complete agreement. So I just picked the one that seemed the most reasonable to me and went from there. As a mast cell patient, any diet you pick will require customization.

The diet I picked was the Histamine and Tyramine Restricted Diet by Janice Joneja. It can be found on the Mastocytosis Society Canada page.   I like this diet a lot. I do not know Dr. Joneja personally, but when I read diet/nutrition articles by her, I find them to be based in science. They meet my common sense rule. I’m going to summarize the general guidelines of the diet below along with my comments.

Key guidelines for a low histamine diet:

  • Anything fermented should be avoided. Fermentation produces histamine as a side product. Some are only sensitive to yeast fermented products while some find that fermentation from any organism is triggering.
  • No preservatives and no dyes.
  • No leftovers and nothing overly ripe. This is one of the harder parts of this diet, but I find it very important. Fresh or frozen products seem okay. I have mixed success with thawing frozen meat, but lots of people do it successfully. The key is to not cook something, put it in the fridge and eat it three days later.
  • No canned products.
  • No pickled products.

Milk and milk products: Avoid fermented products, like cheeses of all kinds, kefir, yogurt, sour cream, cottage cheese and cream cheese. A fair amount of milk products are allowed. Milk (cow, goat, coconut) is allowed, as are cheese type products that are made without fermentation (mascarpone, ricotta, panir.) Some versions of this diet allow mozzarella cheese and I find that it is safe for me. Ice cream is allowed if it doesn’t contain other disallowed ingredients. Cream products are okay, too.

Grains, breads: Yeast is the component most likely to be triggering in these products. Many people choose to restrict gluten due to their individual biologic reactions to it. Gluten is not specifically restricted on this diet, but I can tell you that it basically ends up being excluded anyway because gluten containing products usually also contain yeast. Pure, unbleached flour or grain of any kind is allowed. Products that use baking powder for leavening are allowed, like biscuits, soda bread, scones and muffins. Crackers without yeast are allowed, as are cereals if they don’t contain excluded ingredients, including artificial dyes or preservatives. I have a very difficult time finding low histamine baked products that are premade, so I generally make my own. It is surprisingly easy to make good tasting baked products with safe ingredients at home.

Vegetables: The list of vegetables that aren’t allowed feels really disjointed and counterintuitive. There is not much to do beyond committing it to memory. Not allowed: potato, avocado, green beans, eggplant, pumpkin, sauerkraut, spinach, sweet potato, tomato, any overly ripe vegetable. I personally can eat potato and sweet potato without any problem and do pretty much every day. Removing tomato was a revelation for me. It’s hard to live around because we use it for so much, but I really feel so much better. I will sometimes have a little for immediately get a stuffy nose and headache. All other vegetables are allowed. Any green that is NOT spinach is allowed. I eat a huge amount of squash, which is a really versatile ingredient. I get lots of different types from supermarkets or farmers’ markets and I make soups, purees, baked squash, squash lasagna, squash steaks, and a million other things. I can always tolerate it. This diet has also pushed me to get familiar with less common ingredients, like taro root, breadfruit and lotus root.

Fruits: Again, the list of fruits that aren’t allowed doesn’t provide any obvious unifying factor to quickly identify something as safe or not. Not allowed: citrus fruits, including lemon and lime; berries, including cranberries, blueberries, blackberries, gooseberries, loganberries, raspberries, strawberries; stone fruits, including apricots, cherries, nectarines, peaches, plums, prunes; bananas, grapes, currants, dates, papayas, pineapples, raisins. Allowed fruits: melons (keep in mind that some people may have an oral allergy syndrome reaction to melons), apple, pear, fig, kiwi, mango, passion fruit, rhubarb, starfruit (not safe for those with impaired kidney function), longans, lychees. I eat a lot of fruit, especially apples and mangoes.

Meat, fish and eggs: All shellfish are prohibited. They naturally have a huge amount of histamine. No processed meats (cold cuts.) Eggs are allowed if they are allowed. Raw egg white is a HUGE histamine liberator. Fish is allowed ONLY IF IT IS FRESHLY CAUGHT, GUTTED AND COOKED. There are differing opinions on what this means but several sources estimate it must be cooked in less than 30 minutes from catching. So unless you are or are married to a fisherman/woman, I think this is unlikely to happen. Any meat should be fresh or thawed from frozen. Leftover meat should not be consumed.

Legumes: Soy is the big culprit here because it’s in everything and is not allowed. Also not allowed: green peas, sugar or sweet peas, red beans and tofu. Everything else is allowed, including lima beans, chickpeas (I eat a ton of chickpeas), pinto beans, white beans, navy beans, black eyed peas, black beans, lentils (I also eat a ton of lentils), split peas, peanuts, and real peanut butter.

Nuts and seeds: All okay except for walnuts and pecans.

Oils: All okay except for oils that contain preservatives like BHA or BHT.

Spices: No anise, cinnamon, clove, curry, cayenne, nutmeg. Everything else is okay.

Sweeteners: No unpasteurized honey, chocolate, cocoa beans, cocoa. Most others are fine, including pasteurized honey, sugar (of really any kind), maple syrup, pure jams and jellies. This diet says plain, artificial sweeteners are okay. They are definitely not for me. One of the very first things I was told by mast cell specialist was not to use artificial sweeteners. So you can judge for yourself.

Drinks: A lot of drinks are restricted, including all teas. Most fruit juices and drinks have some type of unapproved ingredient. Milk, pure juices, water, mineral water and coffee are the allowed drinks. I also sometimes make “muddled” drinks where I crush some safe fruit with a mortar and pestle, make a simple syrup, and then put the muddled fruit in some soda water with some simple syrup.

Miscellaneous: Not allowed: Yeasts, yeast extract, all vinegars, flavored gelatin. Allowed: plain gelatin, cream of tartar, baking soda and baking powder.

The diet recommends a strict four week adherence to determine if it works. I think this is pretty accurate. I did it with no cheating for five weeks. It helped a lot. I slept better, I wasn’t swollen all the time and I was less nauseous. But there were some downsides. The first is that it is a royal pain in the ass if you work because you really have to cook every day. The restrictions on meat meant that I had meat about once every 2-3 weeks. Not everything freezes well so making a lot ahead of time isn’t always a good idea.

Finding recipes can be hard because the fact that they are labelled low histamine does not mean that they ARE low histamine. Please be very careful with that. I also find that some sources for low histamine recipes seem to assume a high level of economic freedom in food purchasing, as well as access to expensive and difficult to find ingredients. I can shop at Whole Foods, which has a knowledgeable staff and a good stock of ingredients for diets like these. There were several components I still cannot find. I also spent literally $1000 at Whole Foods for the five weeks when I initially did this diet.

One unexpected result of this diet was that it resensitized me to foods that I had become desensitized to. So foods that used to bother me a little now cause a severe reaction (sometimes anaphylactic, requiring epinephrine.) I understand that the reason for this is because these foods always caused reactions but I was effectively “used” to them so I didn’t notice. Regardless of the reason, my life is a lot more difficult foodwise than it used to be. I can “cheat” with some foods with medications but the reactions are still bad. I don’t always know how I feel about my choice to do the low histamine diet in my particular situation, but the fact is that since I did, I now am forced to observe a version of it, probably for life.

So that’s my run down on the low histamine diet.

 

 

21 Responses

  1. natasha December 18, 2014 / 7:22 pm

    Are you able to cook meats ahead of time and immediately freeze them and reheat later without reaction? I had to stop eating leftovers after a bad experience with awesome curried chicken years before knowing leftovers were bad.

    • Lisa Klimas December 20, 2014 / 2:34 am

      I have not had much success with this, but to be honest, I think it’s partially a taste thing for me. Lots of people cook their meals and immediately freeze.

  2. Yvonne December 18, 2014 / 7:35 pm

    Wonderful summary of the low histamine diet. I have found the same problem with resensitization. My daughter seems more sensitive than me and when she feels a problem such as ” my throat is sore , or I have trouble breathing” I am OK for a while then develop the same problems. I worry for her. I know I need to reduce her histamine load but does this mean her world is going to get smaller. On Facebook some people say that their safe foods are now getting reactions to. Is this going to happen to us too? Are there any people who have been on a low histamine diet and didn’t get more reactive?
    Is it possible to reintroduce reacting foods in a low dose to develop tolerance (similar to immunotherapy)?
    Please post more…

    Thanks again so very much!

    Yvonne

    • Lisa Klimas December 20, 2014 / 2:36 am

      Some people find that after a period of stability, they are able to reintroduce previously offending foods in the manner you have described. It’s interesting, I also find that I am less likely to react to foods now that I have done a couple of months on soft solids/liquid diet, so at least part of my reaction seems to be from the literal process of digesting. It will be interesting to see what I can reintroduce.

      • Yvonne December 21, 2014 / 5:39 pm

        Thanks for your reply. I love puréed soups and I always can count on them if I need something filling, non-reactive, and nutritious. Love your posts! Good health to you. 😀

  3. Daryl Neal December 18, 2014 / 9:01 pm

    A timely (for me) well thought, concise, easily understood article Lisa. Thank you.

    • Lisa Klimas December 20, 2014 / 2:36 am

      Thanks! You’re welcome!

  4. peggoty January 4, 2015 / 11:34 pm

    I am about to embark on some dietary changes to include low histamine foods. I am definitely confused by the many contradictions I have read. I think I will start with this one and try to make it 4 weeks!
    I do not have a diagnosis of mast cell related disease, and I don’t know where to begin other than by trying diet first.

    • Lisa Klimas January 5, 2015 / 4:49 am

      Yes, it is confusing. There is a lot of confusion and dissent even among people who really understand histamine metabolism, so I think the best way to find out if it helps is just to try. Eating low histamine is burdensome, especially in the beginning, because it is expensive and requires a lot of cooking as leftover meats (and for some people, leftover anything) is not allowed. But it can really be life changing to figure out what foods are worth eliminating to promote feeling better. Good luck!

  5. Colleen March 25, 2015 / 9:46 pm

    Hi sorry to bother you but as a newly diagnosed mast cell disorder patient I found your blog extremely fascinating and helpful.

    I was hoping I could hit you up with a few follow up questions regarding meal prepping if its ok 🙂 blush

    I’m really struggling when it comes to prepping lunches or snacks to be eaten away from home… (When I cannot eat everything pipping hot the moment it comes out of the oven-especially since I have OAS and cant eat raw fruits and veggies or drink smoothies on the go)

    I was wondering..
    How long do you have to eat “safe” baked goods or snacks you make from scratch at home before the histamine levels rise in them & become unsafe..

    For instance…could I bake some fresh breads or muffins in the morning and eat them away from home at lunch time?

    Or would it be better to make them the night before, freeze them, (once their cooled) and then eat them for lunch the next day (as they should be thawed out by lunch and freezing stops histamine production from the bacteria)?

    Same goes for homemade snacks like popcorn (I buy mine straight from a mill so their not treated with massive preservatives and sulfites) or zucchini chips? Would they last all day for snacking or would they have to be eaten immediately to not cause a histamine overload

    If you don’t mind…
    Could you share what you do when it comes to eating away from home with mast cell problems? Maybe some ideas for lunches or snacks? (My dietitian wants me to get 1500 calories & 50 grams of protein in a day which is hard to do when your out and about and have mast cell problems & are nut free & dairy free)

    Thanks so much 🙂
    (Hope I explained that ok)

    • Lisa Klimas March 25, 2015 / 11:02 pm

      These are all excellent questions. I’ll do a post that answers all of them. 🙂

      • Colleen March 26, 2015 / 1:45 pm

        Thank you so much Lisa *hug. I really appreciate you taking time out of your extremely busy schedule to help guide me and others with mast cell problems (especially when you have an upcoming surgery looming overhead-if ever there was a time to take time off from your blog and focus on yourself & be selfish it would be now and no one would fault you for it. Shows what a big kind heart you have 🙂 wishing you the best with your upcoming operation & a safe and speedy recovery )

    • Patrick Jordan May 24, 2016 / 7:08 am

      Hi Colleen,

      I have been plagued by a thought that a friend put in my mind decades ago: Why is it that our parents left the thanksgiving dinner out on the table for hours and ate leftovers at room temperature for days yet never got ill? When I read your comment about food that had to be eaten nearly as soon as it was cooked, it made me wonder about home environment. Are you aware of any mold or mildew problems in your house (most folks just focus on bacteria) that might contribute to ‘allergic’ reactions beyond the obvious histamine? I remember a warning years ago that hot air poppers sent aspergillus spores from the popcorn into the air causing lung problems. I’ve noticed runny noses from unrefined salt, so there is no subtance that is not able to be colonized by many different phyla of microbes.

  6. Matt February 29, 2016 / 11:41 am

    Lisa, thank you for your online contribution to those of us navigating the low histamine/histamine intolerance lifestyle! I too find Dr. Joneja’s outlined diet to be the most scientific focused. She did a great interview posted on YouTube with the Low Histamine Chef that fleshed this out as well. Your comments and ad lib are extremely helpful since this is a very un-covered disease state, and thus feedback and reviews of diets and foods are indispensable.

    I am now coming to realize that I too have a huge histamine intolerance and keeping them to a minimum is really, really helpful. I’ve struggled with Lyme Disease, many autoimmune disorders (perhaps not if histamine was behind them all along), and constantly getting triggered into a histamine rampage when I thought I had found all the culprits in my diet.

    The worst of it all is that I got massive panic attacks, very physical restlessness and anxiety, and palpitations when my histamine bucket overflowed. My symptoms were certainly uncomfortable in the physical sense (chest pain, chronic constipation and/or diarrhea, swelling of the sinuses, inner mouth, throat, and dulled hearing) but the psychological aspects of the induced anxiety were the most unbearable and have forced me to exit many social opportunities as well as hamper my job performance. I’ve nearly had to quit not knowing what was happening to me and having literally weeks on end of histamine overload, disrupting sleep, and constantly struggling just to get by. For people who do not see histamine intolerance as a disease state or view it as much less of a problem than many medical diagnoses like cancer, lupus, dementia, and so on, I’d dare them to walk in our shoes!!

    Going forward, the hardest part of all of this is relating it to real life and the foods we eat in the United States. I’m seriously excited to try and incorporate basic milk, some grains and legumes, and perhaps some decaf coffee down the road. We shall see.

    Thank you again for this post and I hope my story helps others too!

    • Patrick Jordan May 24, 2016 / 7:12 am

      Hi Matt,

      The ancient chinese defined anxiety as not being able to breathe = hypoxia.

      When the lactate to pyruvate ratio is altered you can get anxiety to panic attacks.

      Look to your methylation status not just histamine for answers. Methyl groups are what help to recycle hormones/neurotransmitters. They’re not just for locking down gene expression.

  7. Celine March 16, 2016 / 4:09 pm

    Hi
    Are you sure about THe nuts and deed part ? Because i read a lot and on Every list peanuts are high in histamin, and pecan is ok. Pumkin steeds zee ok but sunflowers not . Wijst do you think? I still feed bad in my stomach so i definitely don’t have The good list so if you are really sure about yours that’s great ! And blueberries ? Really ? On other Lists these are often ok ! 🙁 and melon… Isnt their a difference between Galia en cavailon ? Greetings from Belgium Celine

    • Lisa Klimas March 18, 2016 / 3:21 pm

      Hi, Celine,

      There are several versions of the Low Histamine Diet. Unfortunately, none of them are definitive because there have been no real studies of the histamine content of foods. The version I use, by Janice Joneja, works very well for me. This version allows nuts and seeds. So there isn’t really any way to know until someone does a study.

      My French is not great, but I’m pretty sure that cavailon is cantaloupe (which per the Joneja list is allowed as low histamine) and I think that galia is a general term for melons. Per the Joneja list, several melons are safe. Like lots of other diets, you will have to try most foods to know if it is safe for you. Hope this helps.

      Best,
      Lisa

  8. Patrick Jordan May 24, 2016 / 6:42 am

    Hi Lisa and everybody,

    I am looking forward to studying these pages looking for patterns. There will always be individual variations but for the most part what folks are looking for are general guidelines that can keep them from crashing hard. The trouble being: even if a histamine guideline was adhered to, then there are multiple other confounding factors that would make those without a degree in biophysics give up. For example: Mangos are raved about by some, but if you merely touch a mango to your lips and your lips and tongue goes numb then this is a precursor to anaphylaxis. Personally, I think mangos taste horrible. I do like cooked quince, but when your body parts start buzzing like benedryl then you know there is a problem. So I did an experiment: I properly anaerobically fermented the quince and was not only able to eat it without cooking it but it didn’t threaten to require an epinephrine shot just to have a snack.

    I was told that all peanuts have aspergillus that makes aflatoxin that is a potent liver toxin and carcinogen EXCEPT for valencia peanuts grown in New Mexico. I have not experimented with this because peanuts are to be avoided due to their lectins in the blood type diet. So: mold or molecular biology? (or histamine?)

    I have been at this game so long that I no longer consider the food or its contents as something to be controlled as a thing delivered to the host (us) but rather in the light of the MIT article on glyphosate toxicity that the gut biome has been forced to adapt to a toxic environment so it might require or react to things that we put down the gobhole in an altered way. Therefore: was the problem the peanut or the mold or the lectin or that when a genetically mutated microbe in the guts had at your sandwich it pooped out something that your body could no longer tolerate?

    Thing of it is, kids, I actually THRIVE on most of the list of fruits to avoid. There can’t be that drastic contradiction unless there were compounding factors or something completely different that is being missed in this situation. I welcome all input on this matter.

  9. Patrick Jordan May 24, 2016 / 6:51 am

    So sorry: I was on a rant on the confounding factors and forgot to throw in my favorite: Curcubitacea.

    The MOMENT that a fruit of a melon, or squash (zucchini) or cucumber is set after pollination it is colonized by fungus. The rule to eat melon alone or leave them alone is based on the fact that melon is totally infiltrated by mold so it must be digested fast since the fungus will bloom at body temperature. It really begs the question then, of what these fungi are doing to modify histamine status of a meal, the consumer, or the microbes in the gut of the consumer???

  10. Janine June 7, 2016 / 11:52 pm

    Hi there, thank you so much for this information and sharing with us! The vegetable that I’m wondering about, although not a very popular one is parsnips. Do you know if parsnips are allowed? And what about carrots? Thank you so much!!!

  11. Carla Rodrigues June 11, 2016 / 9:45 pm

    Thank you for sharing this has helped me a lot just to even know there is someone out there who understand the pain and the frustration and the struggle and will several trials I am starting to get my self to a comfortable level and yeah the cooking everyday and know what to cook us difficult,

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