Letzte Aktualisierung am 9. March 2025 von Dr. Michael Zechmann-Khreis
Histamine intolerance is a complex metabolic disorder in which the body cannot break down histamine efficiently. This leads to a variety of symptoms, including headaches, skin reactions, digestive problems, circulatory problems and respiratory symptoms. The treatment of histamine intolerance requires a combination of a targeted diet, supportive medication and a healthy lifestyle. As the tolerance of foods varies greatly from person to person, it is important to take time to change your diet and determine your own tolerance level through a structured test phase. In most cases, a long-term balanced diet that is adapted to individual needs can significantly reduce or even completely prevent symptoms.
Recognizing and treating histamine intolerance
Diagnosing histamine intolerance is not always easy, as the symptoms vary from person to person and can be confused with other intolerances. An essential step in therapy is therefore to keep a symptom diary to determine which foods and lifestyle habits trigger symptoms. One possible cause of histamine intolerance is a deficiency of certain nutrients such as copper and vitamin C, which play a central role in the breakdown of histamine. It may therefore make sense to first have your copper levels tested by a doctor and, if necessary, to balance them with a supplement.
Vitamin C has been shown to support the breakdown of histamine, which is why a targeted intake can help to reduce symptoms. In addition to the nutrient supply, it should also be checked whether any medication taken inhibits the activity of the DAO enzyme (diamine oxidase) or MAO, which are responsible for the breakdown of histamine in the body, among other things.
Dietary changes as a central therapy
One of the most effective measures for treating histamine intolerance is to change your diet in three phases. The first step consists of a so-called elimination dietwhich usually lasts 10 to 14 days. During this time, foods containing high amounts of biogenic amines are strictly avoided in order to find out which foods are problematic and to alleviate the symptoms.
The following foods should be avoided during elimination diet:
- Matured cheese, cured or fermented meat, canned fish
- Alcohol, especially red wine and beer
- Fermented products such as sauerkraut or soy sauce
- Citrus fruits, strawberries, nuts, black and green tea and coffee
Instead, a fresh, low-histamine diet based on unprocessed foods is recommended. Fresh vegetables such as zucchinis, carrots, pumpkin, cucumber or fennel as well as low-protein side dishes such as rice or potatoes are recommended. In general, a pure potato and rice diet is a good start for the first few days elimination diet. A symptom diary can help to record individual reactions to certain foods and to better assess personal tolerance.
After elimination diet comes the test phase, in which individual foods are gradually reintroduced. Tolerance can vary greatly from person to person, which is why it is important to test new foods in small quantities and pay attention to any symptoms that occur. The transition from the test phase to the permanent diet should be as gentle as possible in order to ensure a balanced and well-tolerated diet in the long term.
Animal and plant-based foods in the low-histamine diet
During the elimination phase and testing phase, it is important to differentiate between different food groups. Animal products should be eaten as fresh as possible or frozen immediately after purchase in order to avoid excessive histamine formation. Particularly problematic are matured, cured or smoked meat products such as salami or ham as well as canned fish and smoked fish. Fresh meats such as chicken, turkey or beef are generally better tolerated.
Plant-based foods also contain varying amounts of histamine and biogenic amines. While vegetables such as zucchinis, carrots and fennel are well tolerated, eggplants, spinach and tomatoes should be eaten with caution. Some fruits such as avocados, bananas, strawberries and citrus fruits can also trigger symptoms due to their high content of putrescine and tyramine.
Legume sprouts are a natural source of the DAO enzyme and can support the breakdown of histamine in the body. Mung beans, chickpeas and lentils in particular have a high enzyme activity and can be a natural alternative to DAO preparations.
Histamine liberators
Some plant-based foods are considered to be histamine liberators. A few years ago it was already known that these products do not contain histamine, but that people do react to them. The hypothesis of the body’s own histamine being released by these foods was devised and they were listed as histamine liberators. This hypothesis is now considered outdated and obsolete. Let’s compare the list of plant-based histamine liberators (e.g. citrus fruits, nuts, tomatoes, strawberries, bananas and pineapples) with the list of products that have a high biogenic amine content. They are the same. It is currently considered more likely that there are no histamine liberators, but that the problem is the high biogenic amine content of these products. So we still have to avoid them, regardless of the reason.
Table: Some foods that are considered tolerated and not tolerated during the elimination phase and test phase.
| Lebensmittelgruppe | Sehr gut verträglich | Nicht verträglich |
|---|---|---|
| Gemüse | Zucchini, Möhren, Pastinaken, Kürbis, Gurke, Blumenkohl, Süßkartoffeln, Fenchel, Brokkoli (in kleinen Mengen) | Spinat, Auberginen, Tomaten, Avocados, Erbsen, Sojabohnensprossen, Olive, Zitronen, Sauerkraut und fermentiertes Gemüse |
| Obst | Äpfel, Birnen, Pfirsiche, Heidelbeeren | Bananen, Erdbeeren, Grapefruits, Kiwis, Mandarinen, Orangen, Papayas, Passionsfrucht, Pflaumen |
| Getreide & Beilagen | Reis, Hirse, Quinoa, Haferflocken, Kartoffeln, Mais, alle Getreidearten inkl. Nudeln | Sauerteigbrot |
| Fleisch & Fisch | Frisches, ungewürztes Fleisch (Huhn, Pute, Rind, Lamm), Eier, Kochschinken | Wurstwaren, Konserven, Fischkonserven, Thunfisch, verarbeitete Fische, Innereien, stark verarbeitetes Fleisch (Speck, Trockenfleisch …), Fischsaucen |
| Milchprodukte | Frische Produkte wie Butter, Frischkäse, Sahne, Joghurt, junger Käse (Gouda max. 3 Monate gereift) | lange gereifter Käse, Schimmelkäse |
| Hülsenfrüchte & Nüsse | Macadamia, Edelkastanie (Maroni), Kokosnuss, Hülsenfrucht-Keimlinge | Nüsse, Pistazien, Hülsenfrüchte |
| Getränke | Stilles Wasser, Kräutertees (z. B. Kamille, Fenchel, Melisse), Reis-, Mandel- oder Hafermilch | Kaffee, Kakao, Alkoholika, Sojamilch, Energydrinks, Cola |
| Fette, Öle, Essig, Gewürze | Rapsöl, Olivenöl (möglichst frisch), Butter, Kokosöl, Verjus, Branntweinessig, Apfelessig, Salz (auch jodiertes), Pfeffer | Balsamico, Wienessig, Sonnenblumenöl, Sojasauce, Fischsaucen, Zusatzstoffe, Aromen |
Medication support and natural aids
In addition to a change in diet, drug treatment for histamine intolerance can provide valuable support. Antihistamines block the effect of histamine in the body and can help to alleviate acute symptoms such as skin reactions, gastrointestinal complaints or headaches.
DAO preparations containing the enzyme diamine oxidase are often taken before histamine-rich meals to promote the breakdown of histamine. However, they do not replace a low-histamine diet, but merely serve as a supportive measure.
There are also natural substances that can have an anti-inflammatory and histamine-reducing effect. Vitamin C and quercetin are known to inhibit the release of histamine and have an anti-inflammatory effect. High-quality sources of quercetin are apples, onions, blueberries and green beans. To be honest, it has to be said that the amount of quercetin in these foods is below a relevant level. But it does no harm and at the same time you are taking in vitamin C.
Gut health and stress management for histamine intolerance
A healthy gut plays a crucial role in histamine processing. Probiotics that are specifically designed not to produce additional histamine can help to stabilize the microbiome. Prebiotic foods such as high-fiber vegetables also help to support the intestinal flora. Those who tolerate yoghurt should always consume different varieties as a natural probiotic.
In addition to diet, stress can also have a significant influence on histamine intolerance. Stress promotes the release of histamine and can exacerbate symptoms. Relaxation techniques such as breathing exercises, meditation and regular exercise can help to regulate histamine levels in the body and improve general well-being.
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