Dear Mark: Histamine Intolerance

For today’s edition of Dear Mark, I’m answering one question. But it’s a doozy: histamine intolerance and what to do about it. Now, this is a huge question. As you’ll read below, there are numerous causes, many overlapping. There’s no easy fix. There may not even be a hard fix. However, we can almost certainly improve the situation. In today’s post, I offer Laura my take on what to do about histamine intolerance based on my reading of the available literature. It’s not perfect, mind you. It’s complex and often seemingly contradictory. But that’s how it is with the human body, isn’t it?

Let’s go:

Hi Mark,

I hope you can one day shed some light on histamine intolerance. I am extremely sensitive to histamine and also found out that I am mutated for the DAO enzyme, making my problem even worse. I’ve found it very hard to eat primally, since most of the foods promoted like bacon, sausage, cheese, wine, onions, lemons, vinegar, keifer/kombucha/kimchi, bone broth, and a lot of veggies and fruit, etc., all either contain high histamine or induce mast cells to release histamine, causing a huge reaction. I’m sure other people in the primal community are suffering from this as well and would also appreciate any insight you might have.



Great question, Laura.

Just so everyone knows, histamine isn’t “bad.” It’s a normal biochemical produced by immune cells during certain immune responses that produces some unpleasant but necessary effects. The stuffy nose we get during seasonal allergies is histamine’s most famous product, but it’s also involved in bronchoconstriction, hives, the immune response to bug bites and stings, alterations in blood pressure, and vasodilation. Histamine also promotes gastric acid secretion and acts as a neurotransmitter that can increase and inhibit the release of other neurotransmitters. Histamine is only bad when your body can’t break it down fast enough or you simply make too much.

Why might a person make too much histamine?

Bad gut bacteria: Many gut bacteria produce histamine themselves. If these histamine-producing strains are overrepresented in your gut, you may suffer negative symptoms from any extra histamine.

Mast cell activation syndrome: Mast cells are immune cells that produce histamine as part of the immune response. In the recently-identified-but-still-relatively-mysterious mast cell activation syndrome, a person’s mast cells release excessive amounts of histamine.

Why might a person be unable to break down histamine?

Bad gut bacteria: Many gut bacteria also degrade histamine. A dearth of these histamine-degrading strains in the gut may lead to impaired histamine degradation and increased histamine load.

Diamine oxidase deficiency: Some histamine intolerance stems from a simple deficiency in diamine oxidase, the enzyme that breaks down histamine in the body. Without adequate diamine oxidase, histamine builds up and causes problems where it shouldn’t.

HNMT deficiency: We produce another histamine-degrading enzyme called HNMT, or histamine N-methyltransferase. HNMT deficiency is largely genetic, as various HNMT polymorphisms determine endogenous histamine levels.

A Primal lifestyle is a good idea, but it’s not everything. And because many of our favorite Primal foods are high in histamine or, as you mention, induce the mast cells to release it, when you can’t break down histamine effectively, even eating cherished Primal fare can produce negative symptoms. These foods include but are not limited to:

Anything fermented: pickles, sauerkraut, kimchi, kefir, cheese, yogurt, fish sauce, kombucha, wine, vinegar.

Anything cured: salami, bacon, cold cuts, sausage, ham.

The longer a food is exposed to bacteria or yeasts (even recently cooked food sitting out, IOW leftovers), the more time those microbes have to convert the amino acid histidine present in foods to histamine.

Many slow cooked foods, like bone broth, also increase histamine content and can be problematic in sensitive individuals. For a complete list, check out Chris Kresser’s post on histamine-rich foods (and prepare to be sad). They won’t trigger everyone with histamine intolerance, but it helps to know the potential offenders.

What can you do except avoid histamine-rich or histamine-producing foods forever?

Focus on gut health. I may sound like a broken record, but the gut may be everything when it comes to histamine tolerance. Certain probiotics are histamine-producing (which may worsen your symptoms), histamine-neutral (which will have no direct effect), or histamine-degrading (which should improve your symptoms). If the histamine-producing ones colonize your gut, that’s bad news.

  • Among the histamine-producing, foremost are Lactobacillus casei, Lactobacillus delbrueckii, and Lactobacillus bulgaricus, all of which are found in most yogurts. Avoid those. That’s why fermented dairy is a no-go for most people with histamine intolerance.
  • Take a probiotic that contains histamine-degrading strains, like Lactobacillus plantarum (my own probiotic supplement is one example). Soil-based organisms may also reduce histamine.
  • Eat prebiotic fibers and resistant starch. When choosing a resistant starch source, consider going with unripened green bananas (great frozen in smoothies, not so great as straight-up snacks) and/or cooked and cooled potatoes over raw potato starch. Raw potato starch may aggravate your symptoms, as potato lectins can induce mast cells to release histamine.

Check your intake of nutrients, foods, and supplements that support histamine metabolism and tolerance. Will they cure you? No, unless a frank deficiency in said nutrient is the proximate cause of your histamine intolerance. Might they make you feel better in the short term (which is incredibly important and shouldn’t be discounted)? Yes.

  • Selenium has been shown to reduce mast cell activation and attenuate allergic symptoms.
  • Quercetin, found in capers, apples, citrus, onions, and pretty much every fruit and vegetable, is a potent inhibitor of mast cell activation and histamine release. Supplements are widely available.
  • Vitamin C can regulate mast cell activity. Many histamine intolerance supplements (like quercetin) will often come with vitamin C.
  • Stinging nettle can reduce the amount of histamine the body produces in response to an allergen. In one study, almost half of subjects found stinging nettle to be as effective as over the counter anti-histamine drugs.
  • ECGC, the primary catechin in green tea, also inhibits mast cell activation. You can drink green tea or take supplements.
  • Diamine oxidase is the enzyme that actually breaks down histamine in the body, and it’s available in supplemental form.
  • Common antihistamines like Claritin are fairly well-tolerated, too.

Support the liver. As HNMT (the other enzyme that nullifies histamine) activity takes place in the liver, a healthy liver is crucial for histamine intolerance.

  • Avoid oxidized PUFAs (refined seed oils, bad restaurant food, fried foods). Eat healthy monounsaturated fats and saturated fat instead.
  • Avoid excess sugar, especially refined sugar, and carbohydrates.
  • Eat colorful fruits and vegetables rich in polyphenols.
  • Exercise regularly and stay physically active throughout the day. Deplete your glycogen regularly, as a liver with fully-stocked glycogen stores cannot store incoming glucose/fructose and must convert and store it as fat.

Avoid alcohol. Alcohol is a major DAO inhibitor, making red wine a double whammy for the histamine intolerant.

Watch stress. Corticotropin-releasing hormone (CRH) stimulates mast cells to release histamine. But CRH also releases cortisol, which inhibits histamine secretion. In normal circumstances, with acute, short-lived stress, this works to oppose excessive histamine. In chronic stress, things change. We become resistant to stress hormones, and cortisol loses a bit of its histamine-inhibiting luster. We’re releasing massive amounts of histamine-stimulating CRH, but the cortisol is unable to stem the tide. So: watch stress. Avoid it, limit it, mitigate it, or rethink it. And consider an effective adaptogen/herbal supplement to get yourself over the hump when you need it. (I swear by this one.)

Maintain optimal sleep hygiene. The activity of mast cells adhere to one’s circadian rhythm, so getting inadequate light during the day, excessive light at night, going to bed too late, and neglecting one’s circadian hygiene in general will likely perturb histamine tolerance.

It’s a messy story with too many threads to easily follow, but you can try a few things. Let me know how things go for you, Laura. And everyone else, let’s hear about your experiences with histamine intolerance down below. What worked? What didn’t? What else should Laura try?

Thanks for reading, all!


TAGS:  immune health

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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101 thoughts on “Dear Mark: Histamine Intolerance”

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  1. So maybe this explains why I’ve been having hives for the past 3 or 4 months. After reading Dr Perlmutter’s book Brain Maker in the spring, I started alternating several brands of probiotics (to get different strains), making my own sauerkraut and kombucha, cutting up green banana in smoothies — now I find out it could be the cause of breaking out in itchy welts. 🙁 Well, now I can try stopping all the fermented stuff and see if it helps. Thanks for the info Mark.

    1. It’s really tough to say what can cause hives. I had them years ago before I ever heard of Paleo and was eating a typical diet (though never much junk food or anything like that). When I saw a dermatologist, he said that hives can come on due to anxiety, showers that are too warm, etc., but ‘sometimes we just don’t know what it is’. He said that they can last as long as 20 years or as ‘short’ as 5 years then will disappear as quickly as they showed up. Fortunately, mine last almost exactly 5 years then disappeared. I got though that time using Caladryl or Calamine lotion and benedryl tablets by mouth. That said, who knows, maybe yours are from something else altogether and they’ll go away much sooner than mine–All the best!

      1. I had hives show up one day 17 years ago, had them accutely for 5 and in that time had two babies. They just stopped. Twice since they returned for a few weeks span until August of this year. bam… They are back with a vengeance and meds almost don’t even touch the severity. Almost nightly they now appear in my face. This week I’ve stumbled upon the histamine connection, but I must get my gut healthy. Going to talk about probiotics tomorrow. Keep sending us good info!! It’s appreciated!!

        1. When you are pregnant, your body produces an incredible amount of DAO, something like 500X more than usual. Could be why you didn’t have any problems for awhile after have children.

          1. Yes!! I am now diagnosed with systemic mastocytosis… non.producing of Dao. So very reactive to histamines and my body doesn’t turn them off. But my 3 pregnancies and the years I was nursing after were the best I ever felt in my body. No symptoms. I now know it was the Dao production while pregnant. ?

    2. You might want to see an allergist. Some forms of urticaria can only be treated with meds, such as Zyrtec. While you might be able to fix the issue with dietary changes, if that doesn’t work, it’s worth it to see someone that can help.

    3. The same happened to me after going primal/paleo. I ended up with severe itchy adult acne, and no doctor knew why. I was in my late 40’s then. Not a time for acne. It was deeply embarrassing. I am the only person at the table eating “healthy” , and I look freakin horrible. I figured after years of misery and thousands spent on expensive potions that it was histamine sensitivity. All that bacon, slow cooking, bone broth had done a job on my body. I also cannot tolerate any probiotics. I can tolerate home-fermented red onions. Check the Pick’l-It website for info on histamines in fermented foods. It was very helpful. I use their jars to make onion ferment ( which doesn’t taste sour at all – it’s actually more on the salty side ). I have majorly adjusted my diet to include legumes and buckwheat. That has helped, too.

  2. I only recently cottoned on to the fact that I might have histamine intolerance having been vaguely aware of it for some time. When I read the list of foods, it was like someone connecting the dots: every single food I know to avoid when I get heartburn was on there (incuding, sadly, bacon).

    My most acute symptom is probably the eye itching and frequent headaches, which I’ve had for about four years. It’s fine during the summer as I take meds for heyfever, but I could never figure out why my eyes itched. Seemed to have nothing to do with weather or season or air conditioning. I’m hoping my case won’t be too serious as just by cutting out my daily (low fodmap…) banana and any spinach and chocolate, the eye itching and headaches almost entirely disappeared after a couple of days. I’m already on low fodmap AIP for Hashimoto’s so while I educate myself I just cut out the highest histamine foods for relief, whilst carrying on and intensifying my gut healing protocol. I’m hoping this might be another clue in treating my IBS and PMS which haven’t improved on AIP. Both Grazed and Enthused and Low Histamine Chef are great resources for what to eat (elimination is not a long-term strategy!)

  3. Stinging nettle is amazing stuff. Guy at our farmer’s market always has some. Make tea and any allergy symptom goes away pronto for me. Hope it works for you!

    1. “A weed is an unloved flower”.

      Nettles are “weeds” in my neighborhood.
      Sadly the same with dandelions and comfrey. (The later for the soil and animals)

  4. Great overview for those just starting to approach this issue. I wanted to note, however, that I would never recommend anti-histamines you mentioned, like Claritin. They can actually exacerbate your issues, as they don’t help one process histamine in any way. They mainly numb the histamine receptors in your brain, and since you mentioned that is is naturally present and necessary in our bodies, our bodies can notice the receptors aren’t receiving and ramp up production later. Anti-histamines also inhibit your ability to generate your own DAO, so talk about another double whammy! So, I think all of the other advice and supplements you mentioned are the such safer way to go. And honestly, those suffering from this issues may have to rethink being strict paleo. I still wanted to keep ancestral health in mind, and tried the Perfect Health Diet. I’ve improved so much, although I’ve tweaked it to meet my own needs. The copper that is necessary to make DAO is more readily available in the rice allowed in this diet, and I’ve also added back legumes to aid this process (they contain the MAO also needed to support DAO production). At the end of the day, ancestral lifestyle choices and a diet tailored to your needs, not just pure dogma, can help one move closer to health.

    1. “a diet tailored to your needs, not just pure dogma, can help one move closer to health.”


  5. Vinegars and some types of alcohol (beer & wine in particular) are high in histamines. If you are a fan of raw, unfiltered apple cider vinegar and also happen to be histamine sensitive, you’re probably doing yourself more harm than good because it’s still vinegar and is therefore high in histamines. I found that I can drink hard liquor (such as gin and tonic) with no problem, but drinking a glass of wine with dinner every evening would really do me in. I avoid most fermented foods for the same reason.

    I’ve been somewhat histamine sensitive just about forever. I don’t know if it’s due to bad gut bacteria or is inherited, but I do a lot better if I avoid the foods that bother me instead of trying to force them on myself simply because they’re supposed to be beneficial.

    1. You’re right and I found this out the hard way! My food intolerance test came back with vinegar in the moderate, not severe, category. In hopes of aborting a migraine, and thinking it would be less harmful than some of my strong migraine meds, I took a swig of unrefined ACV. Didn’t know at that time I was histamine intolerant. My throat immediately closed up. I could not breath AT ALL for an agonizingly long 30 seconds or so. I literally had the phone in my hand and had dialed the 9 and the 1 just in case I started to pass out. Thankfully I recovered before passing out. My mouth tingled for about an hour afterwards. So I would issue a word of caution as well about using ACV – may be healthy and good for others, but not for many of us HI folks.

    2. Wines are not necessarily rich in histamines, even though they often are. As a winery, we were confronted with the histamine problem by our customers.
      After devoting some research into the topic, we are proud to have a rather large assortment of wines containing histamine quantities of about or even less than 0.1 mg/l. From histamine intolerance suffering customers report, that they can easily enjoy these wines sans any bad effects.

  6. Thanks for this post, most of my issues are a rash (red skin in the warmest areas of my body) after my fever breaks from fighing a virus. I got them after a unintentional sunburn as well. (Rather unatractive around my neck but I have clothes/scarves to cover it up until it disapates thankfully)
    They aren’t painful and seems to be a result of stressful things like a virus, however, only show up AFTER I start feeling better. Which isn’t often now that I eat well. I will have to see about what I may have eaten previously to make it easier for it to develop….. Food for thought indeed!!!

  7. Interestingly my histamine intolerance got better after I stopped eating gluten. Maybe I had the wrong diagnosis, who knows. They never found a gluten intolerance or anything. I believe I am sensitive to gluten, however. So a primal diet with lots of fresh ingredients has helped me immensely. Wheat should definitely be avoided with histamine intolerance.

    1. There’s growing talk about the cross-reactivity with gluten intolerance/sensitivity and other food groups. My son has noticed that when he has dairy a slip with gluten results in a more pronounced reaction.

      And so much goes back to gut health. I’m beginning to think the gut biota is pivotal to many of these systemic problems, balance this area first and many issues will disappear.

      Chris Kresser (who’s speaking in London last weekend of October) also talks a lot about cross-reactivity as does David Perlmutter and Dr Tom O’Bryan.

    2. the tips of the villi in the intestines are often inflamed in gluten intolerance. The tips are where lactase (to digest lactose) and the DAO enzyme are produced.

    3. I thought I had coeliac but tested negative. I seemed ok with pasta but bread and donuts gave me dermatitis. Now I know I’m sensitive to histamine I figure it was the yeast, not the gluten, that I was reacting to.

  8. I’m happy to see that you are covering histamine intolerance! Now, please cover salicylate and sulphite intolerances. And MTHFR. I believe they might be related or have a strong interplay. Thank you!!

      1. Lauren,
        Can you point me to some resources that will help me? I’m in process of the MTHFR diagnoses, and am having a horrible time with eating things that don’t trigger an “I want to die” reaction. I guess I could live on beans, potatoes, iceberg lettuce and milk, but I kind of want more variety, since I have a family I’m taking care of with meals.

        Thank you!

        1. I know your post came quite a while ago, but I wanted to say I’ve had a good deal of relief through the work of Dr. William Walsh. He touches on MTHFR in addition to methylation, epigenetics, etc. Good info on Dr. Charles Parker’s podcast Core Brain Journal (including three different interviews with Dr. Walsh). I had my DNA done, downloaded the raw DNA file and then plugged into and Promethease on
          to find out what my specific gene mutations are. It’s all been extremely helpful. I’m also fortunate to have a primary care physician who is open to all this and has studied with Dr. Walsh, which is a boon. They’re out there!

  9. It really is hard to eat primally while having histamine intolerance. Half the food recommendations here on MDA give me horrible headaches. It was a mind opener though to finally see all the food I can’t eat on the same list. The “I’m not crazy” feeling was nice. But afterwards, you realize that knowing it doesn’t really help all that much. Plus, there is no real scientific research made on histamine levels present in food so all those lists are contradictory. I have no trouble staying away from anything processed or bad for my health but I really don’t like having to not be able to eat that many healthy and nutrient dense foods. Sorry for the rant!

    1. Chris Kesser’s post, linked to above, has a link to his Paleo Recipe Generator, which allows you to exclude various foods. Mind you, it’s $9.95 a month, but that could be worth it to get some ideas of what you can eat. I may have to try it myself, as my allergies are still insane, though somewhat improved over pre-primal.

  10. Thanks for this post on a complex subject. It’s very frustrating to have so many primal foods off limits. Good resources: Janice Joneja; also the Histamine Chef. One fact I unearthed: the act of EATING releases histamine. So for some folks, eating fewer meals (no snacking) can really help. I notice a difference. My doc recommended a DAO (diamine oxidase) supplement, which helps as well.

    1. This might be the reason that I have been a “natural” IFer my whole life, learned from my parents. If eat once a day, which I usually do, I feel so much better than if I need to another meal for social reasons. Wow.

  11. Thank you so much for addressing this. I’ve had HI for many years but wasn’t diagnosed til two years ago. My primary physician also has HI so she recognized it immediately. It’s really difficult to live with this because the ‘culprits’ are moving targets and many healthy foods can cause serious reactions. Even taking a histamine blocker, Quercetin and Primal Flora, I often have reactions. Some have been life threatening. Salad, bone broth, wine, aged cheese, bacon, many veggies and fruits, leftovers – no way. The other thing is that the “lists” of histamine producing foods varies. The treatment for a reaction is white rice, white potatoes or toast – plain. How’s that for someone that is prediabetic? There is no “cure” short of a “gut microbe” transplant from a healthy individual, and no one really knows if that works because it’s so new. Also, as Coco wrote, knowing all this doesn’t help very much.

    1. See my reply to Coco. Also, have you tried stinging nettle, as mentioned in the post above? Or the probiotic strain mentioned?

      Believe me when I say I understand your frustration. My allergies only improved marginally when I went Primal, and one newer, slightly embarrassing, allergy symptom has gotten a bit worse. Sometimes, the underside of my breasts will itch rather fiercely. When I looked at the list of potential trigger foods, I realized that it was the bulk of what I eat! That was really distressing. But I’ve got Tara Grant’s book, The Hidden Plague, which looks like it may include a bunch of useful info – if I ever actually read it, that is. And then there’s my reply to Coco, which had more useful info.

  12. I also want to thank Mark for addressing Histamine Intolerance. Like many people, the healthier and more primal I ate, the sicker I got. I recognized some of my symptoms on The Low Histamine Chef’s website and haven’t had a migraine since. Keeping a food journal never helped me because I didn’t know what I was looking at and I didn’t understand the “bucket theory”. First, I needed to be able to recognize the chemical groupings of foods–histamine, salycilates and oxalates. These sensitivities very ofter overlap for people–including for me. Then I needed to stop hyper-analyzing what I just ate and think about the whole week. It wasn’t just yesterday’s avocado, it was that, plus something the day before, plus another trigger that day and that time of the month, stress, etc. Also, I disagree with another poster about the use of antihistamines. Some of them are mast cell stabilizers and are wonderful for enabling me to continue to function while reacting. I would have lost my job if not for them. If anyone thinks they have HIT, please check out the Facebook groups for Histamine Intolerance, Salicylate Sensitivity, and Trying Low Oxalates. Wonderful people there with tons of helpful information. Spread the word, please. My only regret is that I didn’t know sooner. PS. Flushing is one of the most universal symptoms. Don’t we all know someone who flushes with alcohol?

    1. Interesting. I couldn’t find anything on antihistamines being mast cell stabilizers, but my searching, and modifying questions in my Google search did lead me to some intersting information. Only a few antihistamines do me any good, most notably Tavist (clemastine) and Benedry (diphenhydramine) are both considered first generation sedating antihistamines, which are also antimuscarinic, which means they block another receptor as well. Interesting…

      So thank you for your comment, which lead me to finding that information.

  13. After reading this, I decided to check out MDA’s probiotic. I noticed, however, that it contains potato starch…the article mentions avoiding raw potato starch. Is the supplement version different/safe?

    1. I would also like to know about the potato starch in the probiotic recommended for histamine intolerance, the article says to avoid it, but it is in the pro optic capsiule, I would order the probiotic but not without a clear explanation.

  14. Mark (and Chris Kresser): I truly believe that the advice everyone is giving about histamine intolerance to “avoid fermented foods and Lacto bacteria” to be wrong. Histamine intolerance happens primarily to people with weak gut microbiota (mostly SIBO). And what you’re telling them is “don’t add more microbes in your gut”.

    That advice is very similar in nature to the bad wisdom of the last 40 years:
    – don’t eat fat, it makes you fat
    – don’t eat eggs, they have cholesterol, so you’ll get cholesterol

    I hope you now see the wrong side of that advice: the patient has a bad microbe gut, and the advice is to stop the patient from altering their gut microbes. It makes no sense.

    Please understand that I do agree that when people eat these fermented foods or probiotics, they GET sick from it. But lacto microbes only release histamine when they have to fight. So what you’ll need to fight the situation (except a good diet) is this:
    – Probiotics that have MEGADOSES of good bacteria, taken for a few days only.
    – Capsule technology that SURVIVES the small intestine, so the microbes can COLONIZE the right side of the gut, with little fighting, and fast (before histamine becomes a problem).

    Unless something like that enters the market, histamine intolerance will remain a problem, and the advise given here and elsewhere (don’t eat this or that, even if these are GOOD foods), are going to end up doing more harm than good to the individual in the long run.

    The other alternative, is to drink a LOT of home-made kefir, and go through a lot of histamine reactions, until the bacteria finally manage to colonize and… win the war (might take weeks, and in the meantime you’d be sick).

    The final alternative is to move to Africa or the Amazon and live and eat with the local tribes. A year later, you should be cured. But I doubt anyone can do that.

    1. Mark did NOT say to avoid Lacto bacteria, he did say to avoid the Lactobacillus strains of casei, delbrueckii, and bulgaricus as they tend to stimulate histamine production. However, he said that Lactobacillus plantarum (still a Lacto bacteria) is a histamine-degrading strain. It’s apparently not a matter of not having enough microbes, but a matter of having too many of the wrong ones, and not enough of the right ones.

      As for your mention of SIBO being caused by having “weak gut microbiota,” everything I’ve ever seen on it says it’s either an overgrowth of bacteria in the small intestines, or too many of the wrong ones. That does not sound like someone who needs mega doses of general probiotics, but rather someone who may need large doses of the right ones. And there are already some probiotics on the market, like Mark’s, that are in capsules that survive stomach acid and bile and make it to the large intestines, where they are needed.

      And in the post above, it appears that once one gets the gut straightened out, folks like me, whose allergies are insane, can probably safely eat many of the things that we were advised to avoid at first. So all those fermented foods should be okay, if added back in cautiously.

      1. I know that, you don’t have to mention the obvious about the lacto ones. I just don’t believe that too much of casei, delbrueckii, and bulgaricus is a problem though. They’re only a problem if, as you said, they have colonized the small intestine, not that they’re a problem otherwise. If they have colonized the small intestine, then not eating yogurt or fermented foods won’t do much good anyway. It requires a different action. And a large dose with probiotics that go directly to the large intestine can be a solution, with casei in it or not (Mark’s brand does NOT DO THAT, they don’t survive all the way through).

        1. Mark’s brand doesn’t survive to reach the large intestines? How did you reach that conclusion? According to the info about it in the store, the capsule will survive stomach acid and bile (which is in the small intestines). So I’m confused.

    2. You’re not entirely correct.

      Not all strains colonize, so sometimes they must be taken for months or years.

      And try telling Seth Roberts about the ‘safety’ of high cholesterol fats. Oops, he died of coronary occlusion…

  15. My 6 year old daughter had this. She got hives that she itched open all the time, had tummy pains and rashes on any sun exposed area. She told me she felt like a dead butterfly. 🙁 The whole family is mercury toxic, mthfr, and had gut dysbiosis, liver and general detox issues. We have been doing a comprehensive program with frequent dose chelation avoiding gluten and processed foods as well as adding healing foods. She takes many supplements. In particular zinc has helped her, as does raw cow milk and magnesium. She also improved by seeing a Chiropractor who uses muscle testing -we would be desperately lost without that (I now do it at home for the entire family with fantastic results)- and whole food supplements. He gave her things for her liver, probiotics that her body specifically needed at the time and other things that helped. Over the past year her symptoms have gradually been improving. Before she could not tolerate anything that caused histamine to be released or contained histamines. She now enjoys raw milk kefir, kombucha, water kefir, homemade pickles, and I use bones, herbs and vegetable scraps to make chicken or beef broth and cook white rice in that as a way to help her gut heal more. I also give her jello squares made with diluted pure cranberry juice and stevia to get more gelatin into her. It is working. As we have added the ferments, she and the rest of us have had LOTS of die off and we have activated charcoal on hand to use (away from our other supplements) daily to clean up the dead candida and bacteria bodies. This keeps symptoms down as we heal. Hope the best for everyone dealing with these challenging issues.

    Oh and the children’s gastro and allergy specialists were absolutely zero help and just wanted her on drugs. To me that’s so very sad because people need real help and aren’t getting it.

    1. Activated charcoal is my secret weapon. Especially after a boozy red wine session. In the mornings after a big night anything I put into my stomach including water activates a histamine reaction, I can hardly see as my eyes swell up and I feel extremely depressed and congested in my head. Having a tea spoon of activated charcoal in a full glass of water followed by another glass reduces my symptoms in an hour or so. Magic, I wish I had of known this ages ago. I also use sacromycese boulardii, garlic supplements , great tea supplements, ginseng and a astragalus to help my condition albeit a chronic one. Hope this helps as years of trial and error has got me to this point. Lots of love.

  16. About a year and a half ago I was diagnosed with Celiac Disease and Mastocytic Colitis (too many mast cells in my large intestine) after 10+ years of illness. I also was tested recently after being GF for nearly a year and have bone loss (enough to be classified as osteopenia)- I am 30 years old. I thought a strict gluten-free diet would be tough, but it’s a cakewalk compared to navigating triggers with a mast cell issue. It is helpful having a real name for something, even if I can’t quite get all my symptoms under control. If you are having GI issues, and are having a colonoscopy, make sure you have a doctor that knows about microscopic colitis and will be able to biopsy and interpret the results. My doctor wasn’t a ton of help beyond the initial diagnosis. Unfortunately it’s trial and error with diet, which takes a really long time.

  17. Excellent article. For anyone with histamine intolerance they should definitely follow Mark’s advice. I used to have a very persistent case of clogged sinuses and drainage causing ongoing coughing that was very frustrating and depressing and I found quercetin and sting nettle supplements to be VERY helpful. It may take a couple of months for it to take full effect however.

  18. This is eye opening. I could discuss my own issues with rashes (slogan, “don’t do anything rash”) but I will hold back. My dad and I both have “chronic idiopathic uticaria” caused seemingly by different things. Anyway, this is just a totally different lens through which to view these problems. I will study this thread and carefully consider this new info. Thank you!

  19. There is no mention of Oxalates in this article. Oxalates cause histamine to be produced in the body. If a person is also Oxalate sensitive that means eating even less foods!!! 🙁

  20. NAC and the leaky gut supplements from Gluten Free Remedies were a big help for the histamine intolerant in our household.

    Histamine intolerance can show up as anxiety, not just as hives.

  21. I’ve suffered from nasal congestion and headaches – what feels like a low-level migraine – all my life.

    Histamine intolerance sounds like one more possibility, but what is the most effective way that I can find out without having to endlessly experiment with different food exclusions?

    The original question mentioned a specific gene. If I go for genetic testing, which genes do I need to have them test for, and who does this as part of their normal package?

  22. Could someone post a few “recipes” for stinging nettle tea? Young plants, full grown, before or after going to seed? Does it matter? We have a lot of it on our farm and I curse the stuff every year… who knows, maybe next year I’ll go looking for it. Please let me know some specifics on stinging nettle tea. And seriously… who in their right mind first thought to make that bastard of a plant into tea? Probably some pissed off wife trying to poison her husband. Haha!!

    1. Hi Marti, don’t curse it, butterflies need it as food, it makes valuable habitat. I’d go for young leaves and brew them fresh, if you have them available. Lemon is supposed to make it taste better. BTW, there are better ways to ged rid of an unwanted husband, poisoning is the last resort 🙂

      1. Hi Marti,
        You can forego the pasta of course. I post this for the recipe.

        But really, I buy my nettles dried and in bulk from Whole Foods, and sometimes from Mountain Rose Herbs online, and then steep them as a tea with or without other herbs/tea. It’s a distinctive taste, but I don’t think it’s hard to get to enjoy it.

        I concur with Margit about only using the young leaves. My understanding was even to only harvest the young leaves in the spring.

        1. I meant “I post this for the pesto part of the recipe.”

          Even primal living doesn’t prevent typos, it seems.

  23. Hi Mark,
    Thank you for answering my question!! Your answer is incredibly informative. I will try your suggestions and report back.
    Thanks again,

    1. Oh my goodness. Thank you, Laura, for asking the question. I had no idea that histamine intolerance even existed, but am pretty sure it’s the answer to various questions I have. It’s taken me the better part of the week to come to terms with the implications, but I’m very grateful to have this information. You were right. There are others of us dealing with this very same thing. It’s not every day that I read something life changing, but today (or last Monday, really) might just be that day.

      Thank you also, Mark, for posting answers to Laura’s question.

  24. How do sulfites fit into the picture? I suffered horrible sinisitis and hayfever which became increasingly worse year after year. Since Paleo, nothing, Not even a shadow. (Although I still have a weird mucous reaction with some things, sweet things, like pumpkin or banana.) But when we went Primal, we also cut out all sulfites. No vinegar for a year, we’re only just now re-introducing. I really read the labels – no bacon, no prosciutto, no bresaola – if there is anything other than Ascorbic Acid as a conservative, I won’t buy it. If I don’t know what those numbers or chemicals mean or what they do, they won’t make it into my shopping trolley.

  25. Have itched and twitched most of my life. Thanks for this information, going to give the suggestions a try.

  26. I’ve always been histamine intolerant, and have had bouts of urticaria and sinus issues my entire life, but have been dealing with full blown Mast Cell Activation Syndrome for over two years now. The consistent symptoms started two years ago, and I’ve had them every single day since then, in varying degrees. I’ve dealt with severe flushing, urticaria, bronchial constriction, bowel distress, tachycardia, itchy eyes, extreme sinus congestion, etc.

    Here’s what I’ve learned over the past two years: Don’t drive yourself crazy with elimination diets. Seriously, don’t do it. I have tried them all, including 18 weeks on the the LEAP diet (dietician supervised extreme elimination diet), and had no lasting favorable results. This first time I looked at Chris Kessler’s list, I cried. No joke.

    Honestly, the thing that has worked best for me is close observation. Eat a healthy diet and pay attention to your body. You can identify trigger foods without the nightmare of an extreme diet. You’ll start to notice which foods make you flush, make your heart race, cause bronchial constriction, sinus issues, etc. For me it’s sugar (including certain fruits, coconut sugar, and regular cane sugar), and certain nuts, especially almonds.

    I know this is probably going to make some people here cringe, but Mark said it first, so I’ll throw it out there: Cetirizine (Zyrtec). One of my worst symptoms was extreme flushing. I literally felt like my face was on fire 24/7. Taking just 2.5 mg of Zyrtec every day has almost erased this symptom. (I do still flush if I eat almonds.) I take a 10mg tablet and cut it in quarters. I have also had good results from taking the DAO supplements as well. I hadn’t heard about the green tea until now, but I’m definitely going to give that a try.

    At the end of the day, just try not to stress. Get off of Web MD and quit driving yourself crazy worrying about the leftovers or the 3 day old avocado that might have made you break out in hives. The anxiety will only make your symptoms worse.

    My wonderful allergist told me, that while they don’t fully understand MCAD/Mastocytosis, they do know that some people have experienced spontaneous remission. I’m working on alleviating my symptoms, as Mark mentioned in his post, and holding out hope that this might just go away one day!

    1. Yes, yes, yes!! The elimination diets can make a person become afraid to eat almost ANYTHING! Some of the foods listed I have horrible reactions to, while others Incan tolerate. Stop over analyzing and just listen to your body. Thank you, Mark for this article!!

    2. Great advice on not getting depressed about diets. Thanks for the comment. I also find that DAOsin supplements work great but are pricey – I can even drink red wine with my aged cheese when I take them! Zyrtec worked well for a while in terms of suppressing the symptoms but then suddenly lost all impact. Now I find Levocetirizine works better. I disagree with zealots who say these are a waste of time. Anyone who has suffered these symptoms need relief even if temporary.

    3. I don’t have HI, but I do have cholinergic urticaria and Zyrtec makes it tolerable. I’m also holding out hope that my symptoms will one day vanish like they just one day appeared, but in the meantime, Zyrtec it is. I don’t see why people would be cringing over a person taking a needed medicine. Sometimes a healthy diet, exercise, natural skin care, and natural household cleaners just aren’t enough certain conditions.

  27. Some websites for histamine intolerance list green tea as a DAO blocker. I have had sinus trouble my whole life. As a teen, I had strep throat several times a year which meant antibiotics. I hate to think how many rounds of antibiotics I have taken. Maybe upwards of 50. I tried taking potato starch and broke out in hives. I recently went to an ENT who said I have a sinus infection and sent me home with antibiotics and steroids. When I got home I thought about it and didn’t take them. I have been eating paleo for several months and I have lost a decent amount of weight, yet the sinus problem persists. I am going to eliminate some of the suspect foods. try some probiotics and maybe some DAO supplements.

  28. I was recently diagnosed with histamine intolerance. Sadly there aren’t many cookbooks around for it. I just spent over AU$30 on a “paleo” one from the Low Histamine Chef. I gotta warn you, it’s far more vegan-with-a-blender than paleo. Very carby. Expect lots of fruit smoothies, high oxalate greens and starchy vegetables. Also lots of buckwheat and almond flour. You get only two meat recipes (meatballs; beef stir-fry) and two fish recipes, one in a sugary sauce.

    This is my invitation to paleo cookbook writers: can you do better?

  29. Eye-opening. I’ve been making and drinking kefir milk the last two months. I even strain the whey and use it to make ginger ale and lemonade. First I didn’t notice much improvement from the billions and billions of probiotics I was supposed to be getting from the kefir. And over time, the brain fog and post-nasal drip has gotten worse and worse. With spring in the air, I thought maybe it’s just a particularly high allergen year and my sinuses can’t handle it. But looking back, the symptoms started well before spring though it’s gotten worse the last 2 weeks. Maybe it’s a combination of my body reacting against the probiotics AND the onset of spring?

    Whatever the case, I shall be taking a couple of weeks off from kefir and see if it helps. I started googling the issue because I’m at the point where I can barely function with the sinus pain and fog. With the kefir, I thought it was the lactose that was causing the issues, but over time I realize that my reaction mirrors the symptoms I get when I have sinusitis and that’s what led me to look into histimines. I’ll also head out and pick up benadryl or zyrtec. If they clear things up right away, that should tell me that it’s definitely a histimine problem. The time-off from the kefir hopefully will help with the source of the histimine.

    Is water kefir a low histimine probiotic source?

    1. Just wanted to add that I’ve been eating tons of peanuts lately and I see they’re listed as a high histimine food. So is alcohol. I have always gotten flush from the tiniest bit of alcohol intake and one teacher said I may be allergic to it. Which didn’t make sense to me as a high school student…but it does now.

  30. I get a leaky nose from taking ACV. It seems really bad for my histamine issues. Keep a journal of foods that may be problematic. Alcohol is a big one so is chocolate.

  31. “Among the histamine-producing, foremost are Lactobacillus casei, Lactobacillus delbrueckii, and Lactobacillus bulgaricus, all of which are found in most yogurts. Avoid those.”

    Sorry Mark, that’s a terribly wrong simplification: There is not one unique strain of these 3 bacterias but many strains. And in fact, most of the strains of L.Casei, L.Bulgaricus and L. delbrueckii degrade histamine, and only a relative small number of strains produce histamine.

    I must say to excuse you Mark, that the same simplification appears in practically every blog or forum I consulted in the last 24 hours. I read a lot about histamine intolerance since I discovered I was intolerant to histamine, but as it happened yesterday I’m far from being an expert in that domain.

    Just google something like “Lactobacillus casei strain amine degrade” with a restriction to scholar: you’ll find, for example, that L. casei IFI-CA 52 degrades amines. Note that here L-Casei is the species and L. casei IFI-CA 52 is a particular strain of L. Casei.

    When buying probiotics we should check which strains are included in the capsule rather than avoiding a product as soon as we see L.Casei, L.Bulgaricus or L.Delbrueckii are present. Luckily, some vendors give this information about the strains.

    1. Noegait, thank you. The Natren brand, Megafood, , Supernatant all have the three strains you mention, I wonder if they are the histamine degrading ones? spent so much $$$ on these and then see all this controversy. Could you email me at [email protected]?

  32. Mark, is your probiotic safe for people who are histamine intolerant? Meaning that it doesn’t contain histamine releasing probiotics?

  33. My only comment is that the recommendation for anti-histamines should be removed. Medications like Claritin only act to block H1 receptors (nasal allergies) and make more histamines available to attack H2, H3, and H4 receptors – so other symptoms may get worse if you take them!

  34. Great article, I have MCAD with severe symptoms. I take 8 H1/H2 blockers each day and rescue meds as needed to keep out of the ED. Low histamine (taylored to my sensitivities) is really helpful for me. Im still no where near ‘normal’ and have a lot of chronic symptoms, but it allows me to care for my kids, feel joy again and even exercise a little. Stress management is another biggie, and not getting too tired. It is like holding a sensitive hand grenade, you never know when its going to go off!

  35. Avoiding fermented foods and leftovers help me the most. Recently, i came down with strep throat. During the week that I was sick, before taking the antibiotics, my histamine issues were greatly reduced. No nasal congestion. Once I started the antibiotics along with a probiotic and eating some leftover pizza, my symptoms came back with a vengeance. I will buy Mark’s probiotic to see if this is the problem. I suspect it is. I had to take allegra-d to stop the sneezing, runny nose, etc.

  36. I am highly stressed and read your suggestion to use Primal Calm. Is there another supplement you could suggest for lowering cortisol that has a vegetable capsule? I avoid gelatin caps as I am intolerant to beef.

  37. This is an old post I realize but I found this article and subsequent comments really interesting. I’ve been treated for hashimotos for years and have managed fairly well overall. But recently I started taking ACV and coconut oil daily. Since then, my thyroid gland seems to have swelled, feels more inflamed and is sometimes painful in the throat. I’m noticing a lot of hypothyroid symptoms again. Could it be a histamine reaction to the coconut oi/apple cider vinegar? Thanks in advance for any help!

  38. After battling Cold Urticaria which became apparent in August of 2015 when I spent day at beach with family and came out of the lake covered in hives ,this condition made my life difficult as the cold weather approached any exposed skin got hives ,house kept 23 celsius day and night any changes of temperature made me ill and sweating also caused hives due to coldness of my body trying to cool off.A few months ago I read that Vit D3 in doses of 5000 UI approx taken with Vit K2 to prevent toxicity will cure it guess what it has I can now sit in a room at 20 cel not hives when my hands get cold outside.I am 72 and think that the lack of sun in winter along with too hot in summer contributed to my lack of Vit D I am so happy.i am also aware of foods that cause me excess histamine and eat them sparingly.Also of value to know I tablespoon of olive oil before meals increase DAO by 500%.Magnesium is also helpful in general before meals.

  39. There is no basis, in the literature, to the statement that L. plantarum is a histamine reducing bacteria in vivo.

  40. You should mention GMOs and glyphostate because they destroy the gut and can cause all the things you mentioned.

  41. I have recently found out that I have the gene mutation for DAO enzyme and was looking for a good probiotic. I like the Primal Probiotic, but you have mentioned to stay away from potato starch and I do cause it gives me arthritic pain. So why is it in this product if it would be problematic for histamine intolerance?


  42. Thank so very much for this article. I finally understand what’s going on and what I need to do! I’m desperately trying to heal my severe leaky gut and have come to the conclusion that fermented sauerkraut is what will heal my mucosal lining. However, I get a nasty mental my disabling reaction to eating even a teaspoon of home made fermented sauerkraut.,I’m ordering L. planterum to see if it helps. I wouldn’t have know to take the L. planterum to degrade histamine , if it wasn’t for your outstanding article. I just received another step in the right direction and one step forward in my battle. God Bless You!

  43. I’m hoping to get an answer here. I realize this is an old thred. I have been told and read that green tea is a dao blocker. Is it safe or no?

  44. Watch out with the nettles!!! I never did understand why I never got the touted antihistamine effects from nettles (did daily overnight cold steeps for months) and just recently realized it triggers histamine for me! I did notice feeling a boost of energy from the nettles, coincidentally something histamine also does. Only put it together when I added nettles to my morning tea today after not taking it for months. The sinus congestion was immediate! Apparently, nettles are high in histamine themselves, so depending on the cause of the histamine intolerance they may or may not make things worse.

  45. Good info in this articles, just one thing you forgot; stale bread is a good source of resistant starch. Thank you

  46. Have any of you managed to heal yourselves from histamine intolerance?

  47. I looked at your probiotic because I’m having a major histamine explosion after going off of long term Zyrtec use for allergies. I don’t see Lactobacillus plantarum listed in the ingredients. Confused.

  48. I have just been diagnosed with a histidine intolerance and am overwhelmingly! What are the most important thing to start with ie probiotics or quercieton? What should I do to change
    It’s difficult to figure out what to eat for breakfast as I’m very intolerant to eggs. What breads are ok????
    Thank you

  49. Thank you so much for this article. My husband was diagnosed with COPD and put on a daily inhaler (Anoro). It did give him immediate relief in the am but by night time breathing not good. Using a CPAP machine (low setting). Then acid reflux. Finally pulmonologist said lungs OK and bothered about the asthma. This after much pressing on my part. Were using a lot of kefir etc. So now on low histamine diet and watching food intake. Did have Lyme Disease three years ago and I think gone. Now off the Anoro and breathing managing ok. Thank you again.

  50. My doctor’s didn’t tell me I had histimine intolerance a letter of all my allergies was sent to my boyfriend and he showed me and I thought that’s what the xolair shots were gonna be until I googled it and found cause the shots wasn’t working really now I know it has to do with food and now none of my doctor’s will call me back or let me know what I need to do on a fixed income got crap insurance on top that I’m on oxygen now from being misdiagnosed I’m sure Im now allergic to cockroaches,dust mites,dust, pollen,cats and histimine intolerance and I was born with asthma and a heart murmur I’m 52 and I’m lost at what exactly I can eat and what to do can’t get help because I don’t money for books to read or what to cook or how to fix me I’m desperate please someone help me and did histimine intolerance cause my environmental allergies? Thank you, sincerely LEISA

  51. I’ve been diagnosed with Mast Cell Activation Syndrome. How do I know if it’s that or histamine intolerance or a DAO deficiency? I do use a DAO supplement q5 min before food that has higher histamine and tends to work. Are there any specific tests I should ask for for histamine intolerance or DAO deficiency? I also had a functional doctor that told me I should take Regulat Pro but it’s double fermented!! Isn’t that going to put me in a flare and give me histamine related symptoms?

  52. Dear mark, thanks for article, awareness is so important, because my over load of histamine meant I ended up in hosp each year for 6 years, until I was diagnosed with allergic rhinitis, but I know it’s much more complex than 1 diagnosis fits more self aware of diet , I take all year round histamine, and nettle is helping me cut down on them.i struggled with anxiety, docs thought pandemic, but wasn’t , histamine release we t loopy as I’m going through.enopause, have classic symptoms, iv started to take ginseng, as I was addima t, I would not go down therootof antidepressants. It payed of , thank god for people who share knowledge, to understand you’re body is the first step into listeniNg to it and caring for it better. Thankyou x san