Should You Be Following a Low-Histamine Diet? Here's What a Gastroenterologist Says

Gut health is crucial to your overall well-being, impacting everything from immune function and digestion to mood and mental health. When looking to support gut health, many of us turn to fermented foods like yogurt, kimchi and sauerkraut or high-fiber options like fruits, vegetables and whole grains. But for some, eating fermented foods can lead to gastrointestinal distress that has the opposite effect of the intended benefit, causing discomfort and potentially worsening gut health.

According to a recent Instagram post by Will Bulsiewicz, MD, MSCI (AKA Dr. B), a well-known gastroenterologist and gut health expert, fermented foods can cause painful symptoms like bloating, gas, headaches, runny nose and heart palpitations in some people due to histamine intolerance—a condition where you experience difficulty breaking down histamine (a chemical involved in the immune response), leading to allergy-like symptoms.

In the post, Dr. B said that while histamine intolerance often flies under the radar of gut health, impacting only 1 to 3% of the U.S. population, the actual number of people it affects is likely higher due to how challenging it is to diagnose. 

Dr. B explained that a damaged gut microbiome can compromise your gut barrier, allowing histamine to move from your intestines into your bloodstream. However, he also noted that healing your gut can strengthen your gut barrier, keeping histamine in your intestines where it belongs and preventing it from entering your body.

“When we heal the gut, then we can actually restore competence to the epithelial barrier. And when we do that, we are going to hold the histamine where it’s supposed to be in the intestines and prevent it from getting into our body,” said Dr. B in the post.

So, how can you tell if you have histamine intolerance? The answer is adopting a low-histamine diet in the short term. This approach involves eating low-histamine foods like citrus fruits and bananas and removing culprits high in histamine such as meat, dairy and fermented foods. Once you remove high-histamine foods, your gut can begin to heal. Then, reintroduce them gradually as your gut barrier strengthens and gut health improves.

Fortunately, Dr. B emphasized that a low-histamine diet is only required in the short term. Dr. B states in the post, “Restriction is never the path to better gut health. And it’s important to be completely clear that when you have histamine intolerance, any dietary restriction is intended to be temporary.”

That’s good news since many high-histamine foods are ones you likely know and love, like cheese and chocolate. Dr. B concluded his post, “We’re running through the fundamentals of this topic [...] why it happens, how it’s diagnosed, and most importantly, how it’s treated—without avoiding chocolate, wine, avocados and kimchi in the long run.”

The Bottom Line 

In a recent Instagram post from gastroenterologist and gut health expert Will Bulsiewicz, MD, MSCI, he revealed why understanding the impact of histamine tolerance on gut health is crucial for many people. While a low-histamine diet can be beneficial in the short term to help identify and address symptoms of histamine intolerance like bloating, gas, headaches, runny nose and heart palpitations, Dr. B emphasized it’s not a long-term solution for better gut health. Instead, temporarily removing high-histamine foods can help restore gut health and strengthen the gut barrier, helping those with histamine intolerance restore gut health and prevent gastrointestinal discomfort and further symptoms. Dr. B’s insights highlight the importance of treating histamine intolerance effectively and providing relief for those suffering without long-term dietary restrictions.

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