SIGHI-Leaflet Histamine Elimination Diet Simplified Histamine Elimination Diet for Histamine Intolerance (DAO Degradation Disorder)

Version 2020-07-20

SIGHI-Leaflet Histamine Elimination Diet Simplified histamine elimination diet for histamine intolerance (DAO degradation disorder)

For people with a DAO degradation disorder The compatibility is highly dependent on the in- who have to avoid histamine, other biogenic dividual sensitivity and the amount consumed. amines and DAO inhibitors in their diet. Furthermore, it is temporarily affected by stress, In case of histamine sensitivity due to mast cell hormones and many other factors. First and activation disorders (MCAD) this dietary guide- foremost, the freshness is an important cri- line is not sufficient! If no permanent symptom terion. Everybody has to find out by trial and er- relief can be achieved and maintained with this ror what he/she can tolerate in what quantities. diet, please follow the detailed list, which addi- At the beginning of the experimental diet this list tionally takes histamine liberators into consid- should be followed as consistently as possible. eration as completely as possible. It is available In a later stage, however, the diet should be here: based more on the experiences of the person www.mastzellaktivierung.info concerned rather than following any list. Mast cell activation disorders are often mistaken Always read the list of ingredients to find out for histamine intolerance. whether a food contains incompatible ingredients.

References: • Experience reports from among our members and readers • Various patient leaflets from doctors, clinics and hospitals • Experience of other patient organizations, bloggers, forum threads etc. • Scientific publications • Textbooks and cookbooks about histamine intolerance

To avoid: ? Risky: Well tolerated: Fermented or microbially ripened Meals from res- Prefer fresh, unprocessed or little pro- products (e.g. alcoholic products, taurants, can- cessed basic foods. vinegar, yeast, bacteria) teens, snack bars, The more perishable and protein-rich it Perishable fresh produce with in- etc. are often is, the more important is freshness! It adequate / uncertain freshness badly tolerated for has to be refrigerated uninterruptedly or interrupted cooling chain. various reasons. from the producer to the consumer! Canned, finished or semi-fin- Perishables never leave unrefriger- ished products. ated, not even for a few minutes.

Kept warm or reheated food (es- Let leftovers cool down for a moment pecially fish, meat and mush- and then freeze. Thaw quickly and room dishes), products with a consume immediately.

General long storage time. Prefer vitamin-preserving methods.

To avoid: ? Risky: Well tolerated: Canned meat, cured, dried, mari- Fresh meat sold Natural fresh meat (poultry, sheep, nated, smoked or otherwise pre- over the counter goats, cattle, pork, wild boar), as fresh served meat (-preparations): (no date on it) as possible, packaged and dated: e.g. dry-cured ham, bacon, ... Prepacked cutlet, fillet, chicken legs, turkey Bone-matured or dry aged meat, minced meat breast, ... long hung meat (mainly certain Pre-cooked sau- Frozen meat, thawed rapidly pieces of beef; ask your sages Cooked ham (in slices, without yeast butcher!) Venison, game extract or glutamate) Finely chopped / pureed meat (ripening of meat) Eggs (chicken, quail, etc.) (meatloaf, spreads, cold cuts,...).

Histamine content tends to rise with the degree of comminution. Almost all sausages (e.g. salami, liverwurst)

Meat, eggs Offal, innards (especially liver) Canned fish, marinated, salted, "Fresh Fish" (from Absolutely freshly caught fish (anglers,

dried, smoked or pickled fish and the shop shelf, fishermen, fish farm) seafood. over the counter, Frozen fish (No long-time storage. Certain fish species (in particular from fish markets Thaw quickly and use immediately! Do or in restaurants). shellfish the Scombroidae family): not allow to thaw slowly in the refriger- Tuna, mackerel, herring, sar- Seafood ator!) dines, anchovies, mahi mahi. E.g. pollock, cod, trout, whitefish, Fish sauces perch, organic pangasius Shellfish (mussels, lobsters, rustaceans, c Fish, seafood, crabs, shrimps, prawns)

Matured cheese: hard cheese, Raw milk, yogurt, Fresh dairy products: raw milk directly semi-hard cheese, soft cheese, kefir, sour milk from cow, UHT-milk, pasteurized milk, processed cheese (also known products: acidified butter, cream, whey. as prepared cheese, cheese buttermilk, sour Cream cheese (mozzarella, curd product, plastic cheese), blue cream, crème cheese, cottage cheese, mascarpone, cheese, mold cheese, fondue, fraîche ricotta, goat cream cheese), young

Dairy products aged Gouda Feta cheese Gouda, Butterkäse, Schichtkäse (Possibly yeast and sourdough Malt, wheat germ Potatoes, corn, rice, any kind of grain

, bakery produce with extra long Canned corn? in different forms: granules, flakes, s proving of the dough?) semolina, middlings, flour, pasta, bak- Buckwheat un- ery products, sauces, ...) (Possibly very fresh, still almost peeled? Cereal pastry warm pastries?) Sauerkraut, spinach, tomatoes Possibly green All vegetables except the left called (including ketchup, tomato juice, bush beans, (fresh or frozen). etc.), eggplant, avocado, olives peas? Legumes (lentils, beans, soy, Unfermented soy products such as tofu) olives Pickled vegetables Mushrooms

Vegetables, mushrooms Ceps, morels, agaricus

Miscel- Bevera- Sweets Spices, hydroly- Fats, Fruits, nuts, laneous ges sated proteins oils seeds  Vinegar (especially wine (especially Vinegar vinegar, right) peanuts, ews, exceptions see Nuts walnuts, cash- (especially papaya, guava pears, banana, kiwi, fruits, pineapple, ons, raspberries, Strawberries, nettle ble ingredients, andjuices sodas incompati- with drinks (theobromine), energy Alcoholic soy beverages, milk, chocolate, carobdark cocoaCocoa, brownmass, and Soy sauce, hot spices bouillon, broth sodium glutamate),(glutamate, extract, enhancer Yeast flavor vinegar)balsamic

oranges To avoid To

and other citrus

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White chocolate White oil Walnut parts. and rotten fruits A ierung.info mastzellaktiv- to according Possibly additives presso , es- tea green coffee, tea, black spirits, clear milk, oat milk, Rice void ?

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verripe verripe ?

 jams from acceptable fruits. acceptable fruits. from jams agave syrup,Sugar, honey, stevia, starch potato flour, Binder: or herbs Culinary fresh dried. vinegar apple cider vinegar = spirit herbs, culinary Table oil fish fat, vegetable oils, Vegetable animal fats, chestnuts macadamias, Coconut, taberr ries, cranberries, currants, cassis, j cherries, blackberries, blueber-sour lychee, persimmon, cherries, mango, left fruit All almond milk gredients, andjuices sodas from acce in- ptable nature, rooibos teas, herbal Water, unhealthy.) generally : e.g. apple, peach, apricot, melon, Well tolerated

, fresh, frozen or canned. fresh, frozen y, salt, garlic or garlic salt, powdered),(fresh s corn- = starch, e.g. cornstarch

except coconut milk, coconut water, milk, coconut

mild mild distilled vinegar white the ones

spices.

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Modes of action to the histamine metabolism of foods and additives

It is important to understand what foods affect the ance can have various causes with different underlying pathogenetic histamine levels in which way. Besides food contain- mechanisms. This may be one of the reasons why not all those af- ing histamine directly, there are also those that indi- fected react equally to the same foods or categories of triggers re- rectly influence the histamine levels (histamine liber- spectively. This knowledge is also relevant for medical support ther- ators, diamine oxidase inhibitors, other biogenic amines and sub- apy, because not every drug is appropriate in all the below mentioned stances that affect the intestinal permeability). A histamine intoler- groups.

Histamine-containing foods Histamine is formed as a deterioration product in per- • Fish, if not freshly caught or frozen ishable food, in microbial fermentation and maturation • Meat, if no longer fresh, sausages, dry-cured meats processes and in the ripening of fruit. Even some veg- • Matured cheese, processed cheese (histamine increases with etables are naturally histamine containing, although maturity) very fresh. • Any fermented food, e.g. Sauerkraut Medication: DAOSIN (works best if ingested 15-30 • Tomatoes, spinach, eggplant, avocado min before meal), H1 antihistamines, possibly H2 antihistamines. • Alcoholic drinks, fermented fruit juices • Vinegar, pickled vegetables • Soy sauce, Worcestershire sauce • Yeast extract

Other biogenic amines Besides histamine, there are numerous other bio- • Pineapple genic amines. Several amines share the same main • Banana degradation pathway with histamine: They are com- • Pears peting substrates, degraded by the same enzyme di- • Peanuts amine oxidase (DAO). The DAO prefers other • Grapefruit amines before it degrades histamine. While the DAO is busy with • Raspberries the breakdown of other biogenic amines, the breakdown of hista- • Legumes (lentils, beans, soy products) mine is temporarily decreased or blocked. • Kiwi Some of these biogenic amines have properties similar to those of • Oranges histamine and can cause histamine-like symptoms directly. • Medication: H1 antihistamines, DAOSIN. Papaya • Wheat germ

Histamine liberators The foods and additives listed on the right have the • Alcohol (ethanol) and its degradation product acetaldehyde property of releasing endogenous histamine from • Strawberries certain cell types (mainly from mast cells). This • Nuts (walnut, cashews) mechanism is independent from a lack of diamine • Seafood, shellfish, crustaceans: e.g. mussels, crayfish, crabs, oxidase (DAO). Histamine release is enhanced in ...) persons with mast cell activation disease (MCAD) and to a lesser • Chocolate, cocoa extent maybe also when the enzyme activity of histamine-N-me- • Tomatoes, ketchup, tomato juice thyltransferase (HNMT) is reduced. HNMT is an intracellular hista- • Citrus fruits mine degradation pathway. Even healthy people can react to liber- • Certain active substances and additives in medicaments (see ators if the dose is strong enough. separate list) Medication: H1 antihistamines, cromoglicic acid (or its salt sodium cromoglicate or cromolyn sodium), ibuprofen. DAOSIN has no direct effect against histamine liberators!

Diamine oxidase inhibitors The diamine oxidase is a sensitive molecule that can • Alcohol (ethanol) and its degradation product acetaldehyde be inhibited in its activity by chemical influences. The • Certain biogenic amines foods and additives on the right are or contain DAO • Certain medicments (see separate list) inhibitors that can block the breakdown of histamine • Theobromine by the DAO. It is still too little known about which • Mate tea substances can inhibit The activity of histamine N-methyltransfer- ase (HNMT) can also be inhibited by chemicals, but it is little known about which substances are inhibitors. Medication: H1 antihistamines. DAOSIN just supports the reduction of biogenic amines, but is ineffective against DAO inhibitors!

Increase in intestinal permeability Certain substances affect the intestinal permeability ("Leaky Gut • Alcohol may increase the uptake of allergens from the gastro- Syndrome"). They make the intestines to leak, so that macromole- intestinal tract. The alcohol may influence the tolerance cules and other substances from the digestive tract can enter the threshold of food allergens in a negative way. body, which normally is not the case. This enhances the risk to de- • Hot spices (pepper, chili, curry, etc.) are able to increase the velop an IgE or IgG food allergy or poisoning. intestinal permeability for histamine, which enhances hista- Medication: mast cell stabilizers with continuous application, H1 mine uptake. antihistamines. DAOSIN has no effect in this case!