MCAS Low-Histamine Diet

There are individuals who theorize that some people with MCAS symptoms have a histamine intolerance. Histamine intolerance refers to when the body has difficulty breaking down histamine, so a buildup of this compound can lead to worsening MCAS-like symptoms since histamine is one of the many compounds released by mast cells that can lead to swelling, hives, diarrhea, and other issues.

Determining if an individual has difficulty with breaking down histamine properly is challenging, and research in this area is still lacking. The lack of medical guidance on histamine intolerance makes treatment, diagnosis, and symptom management unclear and difficult to navigate for individuals and their healthcare providers.

If someone suspects that they might have histamine intolerance, they can see if experimenting with a low-histamine diet alongside their medical team reduces their MCAS symptoms. A low-histamine diet contains mostly low-histamine foods and minimizes higher-histamine foods. Everyone is different, so some with MCAS may be able to tolerate some higher-histamine foods, and you may find that what is considered by providers to be “higher-histamine” or “histamine liberators” can vary.

Examples of high-histamine foods:

  • Strawberries, raspberries, citrus, bananas, pineapple, kiwi, pears, and papaya

  • Spinach, tomatoes, eggplant, avocado, olives, and any pickled vegetables

  • Lentils, beans, and soy

  • Walnuts, cashews, peanuts, and cocoa/chocolate

  • Vinegar, soy sauce, sauerkraut, and other fermented foods

  • Soy milk, alcohol, and kombucha

  • Breads made with yeast

  • Canned, cured, smoked, dried meats including tuna, bacon, deli meat, sausages, and some ham products

  • Any canned, dried, or pickled fish, along with tuna, mackerel, herring, mahi mahi, and shellfish

  • Any aged cheeses like blue cheese or cheddar cheese

While some foods are higher in histamine than others, it’s important to keep in mind that histamine content can vary even for the same type of food depending on how it was manufactured, stored, and prepared.

Additionally, some foods are thought to act as “histamine liberators”, which can promote the release of histamine from mast cells.

Examples of histamine-liberators:

  • Citrus

  • Cocoa/chocolate

  • Walnuts and peanuts

  • Papaya, pineapples, plums, kiwi, and bananas

  • Beans, soy, and lentils

  • Tomatoes

  • Wheat germ

  • Most vinegars

  • Food additives like benzoate, sulfites, nitrites, glutamate, and food dyes

You may notice that high-histamine and histamine liberator food lists vary depending on the source. The SIGHI resource is often used as a reference point for low histamine diet food choices, and can be found here. We recommend working with your medical team when considering this document and other dietary changes, as it is not something that should be tried alone.

Written by: Katie Mednick, Registered Dietitian, Nutrition Expert