Low-Histamine Diet: How do I get started & what foods are safe?
Do you need to start following a low-histamine diet? This step-by-step guide will provide some helpful steps for getting started with a low-histamine diet and what foods are safe and what foods should be avoided or reduced.
It can seem extremely overwhelming at first. A low-histamine diet can be a necessity for those of us with Mast Cell disease and MCAS (Mast Cell Activation Syndrome). Many people with ME/CFS and Long Covid also have symptoms of histamine intolerance. When your body produces too much histamine, the high histamine levels in certain foods can cause symptom flares. Some foods are lower in histamine themselves, but they can cause a release of histamine in your body (something called a histamine inhibitor; citrus fruits are an example of this) which can cause worsening symptoms.
Some helpful tips:
Start with an Elimination Diet: Remove high-histamine foods for approximately four weeks. Monitor your symptoms!
Identify Your Threshold: After a successful elimination phase, reintroduce foods gradually to determine personal tolerance levels. I would recommend only one new food component or ingredient per meal, at the very least! You won’t be able to tell what is affecting you if you add everything back at once.
Picture your threshold like a bucket: unlike a true allergy, things are not black and white with histamine intolerance or reactions related to MCAS etc. The more high-histamine or triggering foods you eat, the faster your ‘histamine bucket’ overflows. Sometimes I don’t have reactions until hours or days later because of this.
Maintain a Food Diary: Track everything you eat and any symptoms to identify triggers and patterns.
If you are in eating disorder recovery or struggle with these behaviors, I know this step is extremely daunting. I would suggest not writing down amounts of food or only the specifics that are necessary. Such as: I had scrambled eggs and oatmeal with apples and maple syrup for breakfast. Keep it simple! And if this is too much emotionally, that's okay too.
Emphasize Freshness: Choose fresh ingredients. Avoid canned, cured, or fermented foods and freeze your leftovers. I like to go grocery shopping for fruit and vegetables every few days (although I know this is not accessible to everyone).
Low Histamine Foods List - The Complete List:
Proteins:
Fresh meat (cooled, frozen or fresh)
Chicken, duck, turkey (preferably fresh or frozen)
Certain frozen or fresh fish (hake, trout, plaice, cod, haddock)
Eggs (fully cooked)
Avoid or reduce:
Soy (tofu, edamame, miso, tempeh)
Smoked and cured meat products (salami, ham, pepperoni, bacon, lunch meats, sausages)
Shellfish
Dairy:
Cow’s milk
Fresh cheese (cream cheese, cottage cheese, fresh mozzarella, ricotta)
Diary substitutes
Coconut milk, rice milk, oat milk, almond milk (not canned)
Goat’s milk/cheese, sheep’s milk/cheese (fresh cheeses!)
Avoid or reduce:
Aged cheeses (cheddar, gouda, blue cheese, parmesan)
Buttermilk, Kiefer, sour cream
Yogurt
Ice cream
Most cow milk products
Starches:
Rice (and rice noodles, rice crackers, rice crisp bread, rice flour)
Oats, quinoa, millet, arrowroot, amaranth
Potatoes, sweet potatoes
Millet flour, oat flour, coconut starch, tapioca starch, (some individuals can tolerate almond flour)
Avoid or reduce:
Gluten
Breads with yeast
Beans and legumes in general (dried beans cooked after they are soaked overnight can be well tolerated by some)
Fruits:
Apples, pears, peaches, nectarines
Mangos
Blackberries, raspberries, blueberries
Pomegranates, figs, grapes
Watermelon, honeydew, cantaloupe
Juice (apple juice is a good option)
Avoid or reduce:
Strawberries
Papaya, pineapples, bananas, kiwis, dragon fruit, avocados
Cherries, plums
Citrus (lemons, oranges, grapefruit, lime)
Overripe or stored fruits (as they increase in histamine as they ripen)
Dried fruits (raisins, dates, dried mango)
Vegetables:
Cauliflower, broccoli, cabbage, asparagus
Cucumbers, zucchini, squash, pumpkin
Carrots, celery, bok choy
Beets
Peas, green beans
Arugula, lettuce, kale
Ginger
Leeks, garlic (garlic is high-FODMAP)
Avoid or reduce:
Tomatoes, bell peppers, eggplant
Onions (scallions are low histamine)
Spinach
Mushrooms
Fermented vegetables (sauerkraut, kimchi, pickles)
Nuts, Seeds:
Pumpkin seeds, sunflower seeds
Flax, chia
Brazil nuts, pine nuts
Whether nuts need to be avoided on a low histamine diet seem to really vary based on individual tolerance and the type of nut. Different people have different thoughts on whether some nuts and seeds are truly low-histamine.
Avoid or reduce:
Peanuts (and peanut butter)
Macadamia, cashews, almonds, pistachios, pecans, walnuts (can be tolerated by some)
Herbs, Seasonings, Oils, etc:
Olive oil, avocado oil, coconut oil
Maple syrup, agave, honey, brown sugar
Coconut aminos (some tolerate it, some don’t)
Basil, parsley, cilantro, thyme, rosemary, tarragon and oregano (fresh herbs preferred)
Avoid or reduce:
Cinnamon, anise, cloves, nutmeg, sassafras, allspice
Chili powder, curry, hot peppers, peppercorns, cayenne
Bay leaves, paprika, mustard
Canola oil, soybean oil
Soy sauce
Fermented or preserved sauces or sauces with vinegar (jams, ketchup, bottled dressings)
Others to avoid or reduce:
Chocolate and cocoa products
Caffeine: coffee, energy drinks, caffeinated tea (green tea seems to be the most well tolerated if adding back in)
Fermented or preserved foods (canning, smoking, and pickling can increase histamine levels)
Preservatives and additives (artificial colors, xanthan gum, sulfites, carrageenan, lecithin, MSG)
Leftover food (freeze your leftovers!)
Alcoholic beverages
Be kind to yourself throughout this process. Medically necessary diets are exhausting and take patience to identify your threshold and triggers! You’re not alone.
Feel free to contact me if you’d like support with planning low-histamine meals or are looking for peer-support from someone who gets it. You got this!
Sources include:
Low Histamine Diet- The Chronic Fatigue (ME/CFS) Clinic at Johns Hopkins, Revised 2025
Food Intolerances, Histamine, FODMAPs & IBS Guide; online app by BALIZA
Maintz L, Novak N: Histamine and Histamine intolerance, American Journal of Clinical Nutrition, 2007
Melbourne Functional Medicine: Low Histamine Food Guide, Updated 2024
