Histamine Intolerance and The Paleo Diet


Do you suffer from headaches or migraines? Or is it low blood pressure? Maybe a runny nose? All of these symptoms could be resultant of a histamine intolerance. This vastly overlooked condition can derail many, who would otherwise greatly benefit from a Paleo Diet. But what exactly is histamine and what does it mean to be intolerant to it?

Histamine is a biogenic amine that occurs (in differing amounts) in many foods.1 In a person without an intolerance, exogenous histamine obtained via food can be rapidly detoxified by amine oxidases.2 In subjects with an intolerance, there is usually low amine oxidase activity. Diamine oxidase (DAO) is the primary enzyme which metabolizes dietary histamine.3 Below is a comprehensive list detailing the kinds of foods that may cause reactions in individuals with low amine oxidase activity or commonly referred to as histamine intolerance.


Astute readers will note this list contains histamine-rich foods, as well as histamine-releasing foods. There are other causes of histamine intolerance, besides having low DAO activity4 including ‘leaky gut’,2,3 among other commonly exhibited symptoms as seen in the second table.


Diagnosing a histamine intolerance can be a bit tricky in that you can be tested for allergies, and have negative test results across the board, yet still be histamine intolerant.7 This is a case where the best method of action, is to follow a low histamine diet for a time period, and then slowly re-introduce foods which provoke a histamine response.

Since your body produces histamine8 it is best to think of histamine intolerance as an ‘overflow’ type of situation. Exogenous sources of histamine put your body over the edge. Other causes of histamine intolerance include: allergies, GI bleeding, and small intestinal bacterial overgrowth (SIBO). Endogenous histamine is so important that histaminergic neurons may form part of a “flip–flop switch” hypothesized to regulate sleep and wakefulness9 It is also important to note that antipsychotic drugs can interact with H1 histamine receptors, and may lead to weight gain10 In cases of asthma, histamine can modulate the cytokine network through up regulation of prostaglandin E and nitric oxide11 Then there is the case of atopic dermatitis, which can be improved via a low histamine diet.12 There are also studies, which show that modulation of histamine receptors (specifically H1 receptors) can affect actual dietary intake.13

Histamine-induced food intolerance is not IgE-mediated.14 This means again that the best way to improve a histamine intolerance is to follow a low histamine diet, which can easily be done within a Paleo Diet framework. Diamine oxidase cannot be supplemented; so lowering your histamine intake via food is the best method of action. As stated in this study,15 the only effective long-term therapy for a histamine intolerance is the avoidance of histamine-containing food.


1. Naila A, Flint S, Fletcher G, Bremer P, Meerdink G. Control of biogenic amines in food–existing and emerging approaches. J Food Sci. 2010;75(7):R139-50.

2. Maintz L, Novak N. Histamine and histamine intolerance. Am J Clin Nutr. 2007;85(5):1185-96.

3. Kusche J, Lorenz W, Schmidt J. Oxidative deamination of biogenic amines by intestinal amine oxidases: histamine is specifically inactivated by diamine oxidase. Hoppe-Seyler’s Z Physiol Chem. 1975;356(10):1485-86.

4. Rosell-camps A, Zibetti S, Pérez-esteban G, Vila-vidal M, Ferrés-ramis L, García-teresa-garcía E. Histamine intolerance as a cause of chronic digestive complaints in pediatric patients. Rev Esp Enferm Dig. 2013;105(4):201-6.

5. Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012;42(1):71-8.

6. Andriopoulou P, Navarro P, Zanetti A, Lampugnani MG, Dejana E. Histamine induces tyrosine phosphorylation of endothelial cell-to-cell adherens junctions. Arterioscler Thromb Vasc Biol. 1999;19(10):2286-97.

7. Götz M. [Pseudo-allergies are due to histamine intolerance]. Wien Med Wochenschr. 1996;146(15):426-30.

8. Marieb, E. (2001). Human anatomy & physiology. San Francisco: Benjamin Cummings. p. 414. ISBN 0-8053-4989-8.

9. Williams RH, Chee MJ, Kroeger D, et al. Optogenetic-mediated release of histamine reveals distal and autoregulatory mechanisms for controlling arousal. J Neurosci. 2014;34(17):6023-9.

10. Kroeze WK, Hufeisen SJ, Popadak BA, et al. H1-histamine receptor affinity predicts short-term weight gain for typical and atypical antipsychotic drugs. Neuropsychopharmacology. 2003;28(3):519-26.

11. Packard KA, Khan MM. Effects of histamine on Th1/Th2 cytokine balance. Int Immunopharmacol. 2003;3(7):909-20.

12. Chung BY, Cho SI, Ahn IS, et al. Treatment of Atopic Dermatitis with a Low-histamine Diet. Ann Dermatol. 2011;23 Suppl 1(Suppl 1):S91-5.

13. Mercer LP, Kelley DS, Humphries LL, Dunn JD. Manipulation of central nervous system histamine or histaminergic receptors (H1) affects food intake in rats. J Nutr. 1994;124(7):1029-36.

14. Wantke F, Götz M, Jarisch R. Histamine-free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronic headaches. Clin Exp Allergy. 1993;23(12):982-5.

15. Schwelberger HG. Histamine intolerance: a metabolic disease?. Inflamm Res. 2010;59 Suppl 2:S219-21.

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“11” Comments

  1. Great article. I learned about histamine intolerance a year ago when I saw an allergist. I’ve had exercised induced anaphylaxis for a couple of decades but didn’t realize mine was food mediated. (Didn’t know there was such a thing.) It was kind of like Pandora’s Box being opened when I was told about histamine in foods. I started Paleo because it was similar to how I needed to eat. I just have to subtract ingredients in Paleo recipes–like tomatoes, bacon, etc. You know what I would love? Someone to make a paleo low-histamine cookbook. In hard copy. The Low-Histamine Chef does have a wonderful e-cookbook but I need a hard copy that I can flip through and write in. Every so often I eat foods that are neither paleo or low-histamine. I suffer lots of consequences! I do find it hard to have to eat without wonderful foods like avocado, nuts, or eggplant. I can do without junk food but I miss the good stuff. I think if I eat low-histamine/Paleo for long enough, I can occasionally have some foods like avocado. I do have less allergic reactions from exercise when I’m eating like I need to but it hasn’t gone away. Thank you for the article!

  2. I have severe environmental allergies,(SEVERLY to dust so much that just touching it will make me break out in hives and breathing it will cause asthma attacks, trees, weeds, grass, molds, cats, dogs, cockroaches.) It’s a long list. But, I also have severe histamine intolerance I believe I have had my entire life, looking back at my issues. Anyways, because both are severe, I have to carry Epipen, because I am at risk for anaphylactic shock. My allergist made me start carrying it when I told him my birthday dinner out at a restaurant ended with me having diarrhea, severe abdomen pain, breathing difficulty, chest pain, heart palpitations, and itchy hives. It’s scary. I can’t eat out at restaurants, or at people’s houses, unless I know every ingredient on the menu.

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  8. Hi, i have a leaky gut and have been on paleo diet few months now eating lots of meat, avacado etc. All of a sudden im unable to tolerate meat or avacado.. Seems like ive built up a intolerence level.. My igg alergies are clearfor meat/avacado. The difficult part now is what kind of protein to eat as in my last composition it shows im loosing muscle due to lack of protein. It also showed i need 150grams per day for optimum body.
    Im clueless how to fix this? Thanks

    • Have you tried Histame? It is a DAO supplement that allows you to handle histamine rich food. My wife uses it and swears by it. There is another one called DAOsin that is supposed to be the same. Also she only can eat organic meat that is very fresh. You might try that. She also gets protein from sunflower seed butter.

  9. Casey, in the article you state that DAO cannot be supplemented, but several supplement manufacturers sell it. A Spanish study found it effective in a group of patients with migraine, and it has been very helpful for one of my acupuncture patients.

  10. I started eating Paleo/Wheat Belly Diet in March and have lost 45 pounds. I also became really ill with severe stomach pains and open raw eczema in all the moist areas on my body. My asthma has been in remission, but I suffer from seasonal allergies. I am currently trying to adhere to a histamine intolerant diet, after stumbling on a website when I was researching food intolerances. I believe I have had this all my life. When I was a small girl, about 3 years old, I had severe eczema and I remember my mother applying an ointment she said was very expensive. In my early years I would not eat breakfast and only ate Campbell’s chicken noodle soup. I remember a physician telling me they would have to give me IV’s if I didn’t eat. I was really skinny until I had my first child, then I started gaining weight. Makes sense since during pregnancy the placenta releases DAO. My husband has always remarked how odd my diet was, since I only liked plain food. I believe I unconsciously only ate what didn’t make me sick. I couldn’t believe others could drink lemonade and eat oranges without getting diarrhea . I couldn’t drink a strawberry dacquiri without the same thing happening. People always made fun of me because I don’t drink alcohol I did have complete skin food allergy testing done when I told my physician about my symptoms. Everything was negative and she told me I had food intolerances and I needed to stew my fruit so I wouldn’t get sick. So no help there. I have felt I was left on my own to solve this food problem. I am so happy I can now mend my body, but I am finding that it is difficult to eat enough even if it is my preferred bland food to feel satisfied. My eczema has cleared up, and I can now fall asleep at night. I just wish there was more help in the U.S. Medical practices to help others like me. From my experience I feel histamine intolerance could be the root of many medical ailments today.

  11. I didn’t realize that I had a histamine intolerance until I started Paleo. For the first week of the diet, I felt fantastic. Like you say, though, eating more histamine rich foods (nuts, avocados, strawberries, bacon, tomatoes, etc.) caused my levels to overflow and my body revolted. My throat began constricting when I ate; I experienced reflux, fatigue, and insomnia; I broke out in hives and my lips were swollen.

    I realize now that I’ve probably always been histamine intolerant because I’ve been plagued with allergies all my life, it was just the diet that opened me up to seeing the source of it in the food I was eating.

    I am grateful that Paleo offered that insight, but the physical effects this past week have been awful. I hope that after a few solid days of a non-histamine diet, I can get things back in check and begin introducing more foods and figure out how to do Paleo with this new understanding about how my body processes food.

  12. I have Celiac Disease and food allergies such as dairy and soy, and was still feeling sick, bloated and gassy all the time, even avoiding gluten, dairy and soy. But, I must also have histamine intolerance because prior to going Paleo, I had so many headaches, including migraines, that I was taking Advil EVERY day to keep them at bay! The headaches were so debilitating and affected my quality of life. I was desperate to figure out what was causing them. I had been to a neurologist who put me on medication, but all that did was give me annoying dry mouth. The headaches were reduced on the meds, but never went away and I had to be careful to avoid the migraine trigger foods, such as chocolate, onions, bananas, oranges, etc. I went Paleo and, guess what, no more headaches – ever, I swear! And, I have lost 21 pounds in 2 months, but I am NEVER hungry. I have also stopped taking Nexium for acid reflux and joint supplements for arthritis. Amazing! This diet is not a diet for me, but a life style change. I feel so good that avoiding the forbidden foods is easy! Enjoy.

    • Leisa,

      Thank you so much for sharing your story here. It’s really amazing. I know that Andy Deas, who hosted the earlier podcasts with Robb Wolf, on his site, shared his story of his wife curing her migraines with a ketogenic diet. Migraines are a tricky thing, there are many possible causes. I have helped many clients with histamine intolerances. Most aren’t aware of it, as a possible condition. Glad to see your symptoms have subsided 🙂

      Thanks for reading,

      Casey Thaler
      B.A., NASM-CPT, FNS
      Eat Clean, Train Clean®:
      Eat Real Food, Change Your Life™

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