A Tolerance Kitchen article.
The below content has been created with the input of a range of dietitians and sources. Following a low histamine diet should always be done alongside a qualified dietitian. Your own unique intolerances may make you more susceptible to certain foods than others, and long term adherence can lead to deficiencies in other important nutrients. You can find a list of trusted histamine dietitians here, all of whom offer 1:1 online sessions to help you get started and work with you to create a personalised diet.
Navigating World Cuisines: Part 1
In today's world we have access to a seemingly unlimited amount of world cuisines no matter where we live. Whether that is going out to a restaurant or getting it home delivered, the choices can feel endless.
When we're managing histamine intolerance though, sometimes these choices can feel like a minefield or a reaction waiting to happen. Ingredients that are staples in other cultures can hide hidden histamine (or histamine liberators), and finding the right options can be difficult. The good news is that with a little bit of knowledge and planning, you can find safer options on these menus. This, the first in a series of world cuisine guides, should not be seen as a list of rigid rules. It's framework to help you understand where the histamine is likely hiding and how to make smarter choices. It is all about managing your personal Histamine Bucket.
A Quick Refresher: The Three Main Triggers
Before we dive into the menus, let’s quickly recap the three main ways food and drink can add to your histamine load:
- High Histamine Content: These are foods where histamine has developed through processes like ageing, curing, or fermentation. Think aged cheese, cured meats, and fermented sauces
- Histamine Liberators: These are foods that may trigger your body’s own mast cells to release their stores of internal histamine. Common examples include citrus fruits, tomatoes, and chocolate
- DAO Blockers: Certain compounds in food and drink, particularly alcohol, can inhibit the activity of your diamine oxidase (DAO) enzyme, reducing your ability to break down external histamine
Navigating a Chinese Menu
Chinese cuisine is complex, with a range of sauces and flavours that can feel intimidating at first.
The Challenges: The single biggest issue is soy sauce which is a fermented product and therefore very high in histamine. Many other popular sauces (including black bean, oyster, hoisin) are also based on fermented ingredients. MSG (E621), which is sometimes used as a flavour enhancer, can also be a trigger for some individuals.
Safer Bets:
- Steamed Dishes: This is often your safest section of the menu. Steamed rice, steamed vegetables, and steamed plain chicken or fish are generally excellent choices. You can ask for some fresh ginger and spring onions on the side for flavour
- Stir-fries: This requires clear communication and carries a slightly higher risk. You can ask for a simple stir-fry of chicken or prawns with vegetables, cooked with oil, garlic, and ginger only. Specify “no soy sauce, no oyster sauce, and no MSG”
- Soups: A simple sweetcorn or chicken soup (not hot and sour) might be suitable, but always check if it is made with a pre-made bouillon or stock powder
Navigating a Thai Menu
Thai food’s beautiful balance of sweet, sour, salty, and spicy can be tricky, as many of those flavour profiles come from high-histamine ingredients.
The Challenges: Fermented fish sauce (nam pla) is the foundation of many Thai dishes. Shrimp paste is another common fermented ingredient. Peanuts, citrus juice, and chilli are also widely used and can be histamine liberators for many people.
Safer Bets:
- Coconut-Based Curries: A simple green or massaman curry can be a safer option as the base is coconut milk, which by itself is lower in histamine. You should still ask whether it is made with fish sauce or shrimp paste, as this will change the histamine profile of the meal. Some restaurants may be able to prepare it without on request
- Steamed Rice: Plain steamed jasmine rice is always a safe base for your meal
- Fresh Ingredients: Look for dishes that emphasise fresh ingredients like lemongrass, galangal, and fresh coriander, rather than fermented sauces. A simple stir-fry, similar to the Chinese option above, can work if you communicate your needs clearly
Navigating a Japanese Menu
Japanese cuisine’s focus on freshness can be a huge advantage, but fermented staples are still very common.
The Challenges: Soy sauce is ever-present, as is miso (fermented soybean paste). Pickled ginger and wasabi (which often contains additives) can also be problematic. While fish is generally fresh, some preparations can involve curing.
Safer Bets:
- Sashimi: This can be a great choice. Ask for the freshest fish they have. Slices of fresh tuna or salmon are simple and delicious. Just be sure to avoid the soy sauce for dipping
- Yakimono (Grilled Dishes): Simple grilled skewers of chicken or vegetables are fantastic. Ask for them to be served plain, without any soy-based glaze (get this served on the side instead of over the dish)
- Sushi Rolls: Opt for simple rolls with safe ingredients, like cucumber (kappa maki) or avocado. Again, skip the soy sauce and pickled ginger
- Edamame: Steamed edamame beans with a sprinkle of salt are generally well-tolerated, but as they are soy, it is best to be mindful if you know you react to histamine liberators
Your Toolkit for a Successful Meal Out
Beyond specific menu choices, a few general strategies can make all the difference. You can read more about these in detail in our Guide to Eating Out with Histamine Intolerance.
- Plan Ahead: Look at the menu online before you go. This gives you time to spot potential safe options without pressure
- Call Ahead: Phone the restaurant during a quiet period (like mid-afternoon) to briefly explain your dietary needs. You will get a much better response than when you ask during a busy dinner service
- Keep it Simple: The fewer ingredients in a dish, the lower the risk. Grilled meat or fish with steamed vegetables and rice or potatoes is a reliable fallback in almost any restaurant
- Consider Your Bucket: If you know you are eating out in the evening, you can be extra careful with your food choices during the day to ensure your histamine bucket has plenty of capacity
- Support Your Digestion: For those with a diagnosed DAO deficiency, supporting your body's own enzyme activity can be a helpful part of your toolkit. A DAO supplement like our Aperitif is designed to be taken 15-20 minutes before a meal. One to three capsules can help with the digestion of histamine from food and drink. Do not exceed the maximum daily dosage of three capsules
With a little preparation and knowledge, you can continue to enjoy the wonderful diversity of food that Britain has to offer. Remember, navigating histamine intolerance is a personal journey, and finding what works for you is a process of discovery rather than not restriction.
This article is for informational purposes only and does not constitute medical advice. Please consult a qualified healthcare professional for advice specific to your situation.