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.
The Gut Health Paradox
If you are navigating managing a histamine intolerance, it's likely you've come across a confusing paradox. On one hand, you read about the need to maintain gut health, and the benefits that fermented foods can have here. On the other, you may have learned that foods like sauerkraut, kimchi, and kefir are on almost every “foods to avoid” list (including on our own, which you can find here). It can feel frustrating to be told that the very foods meant to support your digestive system might be contributing to your symptoms.
We understand this frustration. The truth is, you are not imagining it. Most fermented foods are indeed very high in histamine. In this guide, we will break down why this happens, look at specific categories of fermented foods, and explore how you can support your gut health without overflowing your histamine bucket.
Why Does Fermentation Create Histamine?
To understand the link, we first need to look at the process of fermentation itself. Fermentation is a natural process where microorganisms, such as bacteria and yeast, break down carbohydrates (like sugars) into other substances. This process is used to create everything from yoghurt to sourdough bread to wine.
One of the byproducts of this microbial activity can be the creation of biogenic amines. Histamine is a type of biogenic amine. It is produced when certain bacteria convert an amino acid called histidine, which is naturally present in many foods, into histamine.
The longer a food is fermented or aged, the more time these bacteria have to produce histamine. This is why well-aged cheese, cured meats, and long-fermented vegetables are some of the most significant sources of external histamine in our diet. For someone with histamine intolerance, particularly those with a DAO deficiency, consuming these foods can quickly cause your personal “histamine bucket” to overflow.
A Closer Look at Common Fermented Foods
While individual tolerance varies, most traditional fermented foods are not well-suited to a low histamine diet, especially during an initial elimination phase. Let’s explore some common examples.
Fermented Vegetables: Sauerkraut & Kimchi
Histamine Level: High
Sauerkraut (fermented cabbage) and kimchi (fermented cabbage and other vegetables with spices) are created using lactic acid bacteria. Unfortunately, many of the strains involved in this wild fermentation are prolific histamine producers. The histamine content can increase significantly the longer the product ferments. Both homemade and shop-bought versions are generally considered to be high in histamine and are best avoided while you are working to lower your histamine load.
Fermented Dairy: Yoghurt & Kefir
Histamine Level: Moderate to High
The histamine content in yoghurt can be tricky. It depends entirely on the specific strains of bacteria used in the starter culture. Some strains produce a lot of histamine, while others produce very little. For this reason, some people find they can tolerate small amounts of plain, live yoghurt, while others react strongly. It is a very individual food.
Kefir, a fermented milk drink, is almost always high in histamine. It is made with kefir “grains”, a complex symbiotic culture of dozens of different bacteria and yeasts. This complex and uncontrolled mix of microbes makes it a potent source of histamine.
Fermented Drinks: Kombucha
Histamine Level: High
Kombucha is a fermented tea made with a SCOBY (Symbiotic Culture of Bacteria and Yeast). Like kefir, this diverse and wild mix of microorganisms results in a drink that is typically high in histamine. Furthermore, kombucha contains a small amount of alcohol, which can act as a double-whammy by inhibiting the function of the DAO enzyme your body uses to break down histamine.
Searching for Low Histamine Probiotics
Given that most fermented foods are off the table, what can you do to support your gut health? This is a conversation to have with a registered dietitian, who can help you build a diet rich in prebiotic fibre to feed your existing good gut bacteria.
There is also a growing area of research into specific probiotic strains. Studies are beginning to distinguish between bacterial strains that are histamine-producing, histamine-neutral, or even histamine-degrading. For example, some research suggests certain strains of Bifidobacterium may be better tolerated than many Lactobacillus strains. This research is still emerging, and it is most relevant to probiotic supplements rather than fermented foods.
If you are considering a probiotic supplement, we strongly encourage you to work with a practitioner who specialises in gut health and histamine intolerance. They can help guide you towards products that are less likely to cause a reaction. You can find a list of professionals on our about page.