Low-Histamine Diet
Scientific research has demonstrated that diet is crucial in affecting inflammatory processes in the body, estrogen activity, the menstrual cycle, and pain perception. Consequently, diet represents a modifiable factor that holds promise in alleviating the discomfort associated with endometriosis [2]. In this article, we aim to present the impact of a low-histamine diet on endometriosis.
What is Histamine?
Histamine is a vital messenger substance that the body produces, stored in specialized defense cells called mast cells, and releases upon activation. It serves a crucial role in the immune system, acting as a neurotransmitter and a tissue hormone. Histamine regulates various bodily functions, including the sleep-wake cycle, emotional responses, gastric acid secretion, blood vessel dilation, allergic reactions, and inflammatory processes [3],[6].
Additionally, histamine is present in small quantities in nearly all foods and can be absorbed through dietary intake. More significant amounts of histamine are produced during fermentation and maturation processes, leading to higher histamine levels in certain foods like red wine, smoked meats, and aged cheeses [4].
Under normal circumstances, the enzyme diamine oxidase (DAO) breaks down histamine in the intestine. However, in cases of histamine intolerance, this breakdown process is disrupted, leading to an accumulation in the body, which can trigger various symptoms such as headaches, nausea, and skin reactions. Therefore, people with histamine intolerance must adhere to a low-histamine diet to manage their condition [9].
Histamine and its Relationship with Endometriosis
Endometriosis, a chronic inflammatory condition characterized by the abnormal growth of uterine lining-like cells in the abdominal cavity, is associated with immune system dysfunction and inflammation. To alleviate the symptoms of endometriosis, individuals should consider reducing or avoiding foods that contribute to inflammation [1],[2].
Histamine is released by mast cells as part of the immune defense response. It amplifies inflammatory reactions by causing local blood vessels to dilate, tissue to swell, and increased blood flow to the affected area. This biological reaction aims to facilitate the arrival of defense cells at the site of the incident [5]. Endogenously produced histamine and histamine ingested through food can elevate histamine levels under various circumstances, exacerbating the symptoms.
Histamine activates pain-sensing nerve fibers, leading to heightened pain perception [10]. Moreover, histamine has a muscle-contracting effect and can promote painful uterine contractions [16],[20].
Mast cells, which are also present in the uterus, play a significant role in developing endometriosis. Due to immunological changes, individuals with endometriosis exhibit a heightened histaminergic response. This means mast cells release histamine more frequently in individuals with endometriosis than in healthy individuals. In this context, histamine can increase blood flow to the endometriosis sites, heighten pain perception, and exacerbate abdominal inflammation [7],[11],[15].
Reducing factors that can lead to histamine accumulation in the body is crucial. Potential reasons for excessive histamine release or inadequate histamine breakdown can include stress, caffeine, medications, and dietary choices [2],[5]. Later in this article, we will explain how to adopt a low-histamine diet.
Another important aspect is that histamine stimulates the ovaries to produce more estrogen. There is a significant correlation between the growth of endometriosis lesions and estrogen levels [14]. When high estrogen levels are made, a cycle is set in motion because estrogens, in turn, induce the release of more histamine from the mast cells [12]. Estrogen also weakens the enzyme DAO, which is responsible for histamine breakdown [13]. Consequently, histamine levels fluctuate depending on estrogen levels.
Therefore, individuals may be more sensitive to histamine around ovulation and at the beginning of menstruation, necessitating particular attention to a low-histamine diet [18].
It is worth noting that histamine can also impact psychological well-being. In the brain, histamine functions as a neurotransmitter and can trigger anxiety, mood swings, and feelings of depression [17],[19].
What We Know So Far:
- Histamine promotes inflammation.
- Histamine enhances blood flow to sites affected by endometriosis.
- Histamine heightens pain perception.
- Histamine can adversely affect psychological well-being.
- Histamine stimulates estrogen production, and conversely, estrogen boosts histamine release while inhibiting the enzyme DAO.
How to adopt a low-histamine diet?
It has become evident that adopting a low-histamine diet can offer significant benefits, as it aims to minimize the release of histamine from mast cells, thereby reducing inflammatory processes and immune reactions. Additionally, it helps prevent excessive histamine absorption through food.
So, what does this mean for you?
It is essential to recognize that achieving a completely histamine-free diet is impractical, given that histamine is naturally present in small amounts in most foods. Nevertheless, you can still manage your histamine levels through dietary choices.
As previously mentioned, histamine levels in food tend to increase during storage, aging, and fermentation.
Here is a helpful guideline: The longer food is stored or matures, the higher its histamine content. For instance, cheese aged for 6 weeks contains less histamine than one aged for 9 months. Similarly, freshly caught fish has lower histamine levels than fish stored for several hours or days.
Processed, canned, or frozen foods are designed for longer shelf life, resulting in higher histamine content. Importantly, histamine is highly stable and not easily destroyed by freezing or heating. Consequently, fresher foods generally contain lower levels of histamine [21],[22].
However, certain foods can trigger mast cells to release stored histamine, and that is why they should also be consumed in moderation.
In the following list, we will introduce you to various categories of foods¹: low in histamine, high in histamine, histamine-releasing, or having an inhibitory effect on DAO activity.
Table 1: Overview of Histamine-Rich and Low-Histamine Foods [21],[22]
| Food Products | Rich in Histamine | Low Histamine |
| Meat/Poultry/ Fish and Meat Products |
Smoked, cured, marinated, fermented meat and poultry, anchovies, offal, tuna, mackerel, herring, canned fish, raw sausages (e.g., salami). | Basically, fresh or frozen meat and poultry, freshly caught fish (e.g., cod, pollock). |
| Milk and Dairy Products | Aged cheese like Gouda, Cheddar, Emmental, Camembert, Parmesan, processed cheese, etc. |
Fresh milk, cottage cheese, yogurt, young Gouda, cream cheese. |
| Vegetables | Sauerkraut, spinach, eggplant, canned vegetables, pickled and fermented vegetables (beet, cucumbers, onions). | Potatoes, green salad, cabbage, squash, onions, radishes, peppers, carrots, broccoli, cucumber, leeks, zucchini, corn, asparagus, garlic, fresh herbs, etc. |
| Drinks | Alcohol, red wine, white beer, sparkling wine, champagne, fermented drinks, nettle tea. | Better tolerated alcohol:* White wine, light beer, chamomile tea. |
| Other | Red wine vinegar, soy products such as tofu, soy sauce, tomato ketchup. | Apple cider vinegar, fruit gum, popcorn. |
*Note: Alcoholic beverages should be consumed sparingly, as they can inhibit DAO activity.
¹A detailed food list is available from the Swiss Histamine Intolerance Interest Group (SIGHI).
Table 2: Foods that Can Release Histamine or Decrease DAO activity [21]
| Histamine Releasing | Decrease of DAO Activity |
| Citrus fruits
Papaya Bananas Crustaceans Strawberries Tomatoes Pineapple Egg white Peanuts Chocolate Food additives like |
Alcohol
Black, green, and mate tea Yeast Cocoa Energy drinks |
If you suspect you might have histamine intolerance, perhaps due to the presence of symptoms like headaches, skin reactions, and fatigue, it is advisable to maintain a food diary for a few weeks. In this diary, record your dietary intake, including what you eat and drink, and make a note of any symptoms you experience afterward.
Furthermore, reduced activity of the histamine-degrading DAO enzymes can be influenced by various factors, as indicated by [8],[13],[20]:
- Genetic DAO deficiency.
- DAO inhibitors, such as certain medications (e.g., painkillers) and nicotine.
- Insufficient supply of DAO cofactors (e.g., vitamin B6, copper, and vitamin C).
- Hormonal imbalances, such as disrupted estrogen-to-other-hormone ratios like progesterone.
- Damage to the intestinal mucosa.
Summary of Recommendations for a Low-Histamine Diet:
- Prioritize fresh, minimally processed ingredients.
- Opt for fresher options, especially for perishable and protein-rich foods.
- Consider alternatives, such as popcorn or fruit gum instead of chocolate.
- Ensure continuous freezing of foods.
- Thaw and use frozen meat or fish promptly.
- Avoid foods that have been kept warm for extended periods or reheated.
- Maintain a well-balanced, nutrient-rich, and diverse diet to support optimal nutrition for your body.
Low-Histamine Recipe: Quinoa Bowl with Vegetables and Pumpkin Hummus
We are delighted to present a delectable and straightforward recipe for you. The ingredients in this recipe have been cross-checked with the SIGHI food list. However, it is essential to remember that individual ingredient reactions can vary. Therefore, when introducing new ingredients, starting with small amounts and proceeding gradually is advisable. Enjoy!
Ingredients for the Bowl:
- 200g quinoa
- 400ml vegetable broth (histamine-free)
- 1 sweet potato
- 2 handfuls of kale
- 1 zucchini
- 1 carrot
- A dash of coconut oil for sautéing
- 1 tablespoon olive oil
- ½ bunch of coriander
Ingredients for the Pumpkin Hummus:
- ½ pumpkin
- 1 garlic clove
- 3 tablespoons tahini
- 1 tsp apple cider vinegar
- Paprika powder
- Himalayan salt
Preparation:
Preheat the oven and cut the pumpkin into small pieces. Roast the pumpkin in the oven for approximately 15 minutes. Rinse the quinoa with warm water and prepare it according to package instructions, using the histamine-free vegetable broth. While the quinoa is cooking, finely chop the remaining vegetables. Heat a pan with oil and sauté the sweet potato, zucchini, and carrot. Add a pinch of salt if desired. Once the roasted pumpkin has cooled, mash it with the other ingredients until you achieve a smooth purée. Combine the cooked quinoa with the sautéed vegetables, olive oil, cilantro, and a pinch more salt if necessary. Serve the quinoa bowl alongside the pumpkin hummus. Enjoy!
References
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- Jurkiewicz-Przondziono, J., Lemm, M., Kwiatkowska-Pamuła, A., Ziółko, E., & Wójtowicz, M. K. (2017). Influence of diet on the risk of developing endometriosis. Ginekologia polska, 88(2), 96–102. https://doi.org/10.5603/GP.a2017.0017
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