Are apple cider vinegar and rosemary safe in a low histamine (histamine-restricted) diet?

Safety of Apple Cider Vinegar and Rosemary in Low Histamine Diets

Apple cider vinegar should be avoided in low histamine diets, while rosemary can generally be included as it is not a high histamine food.

Understanding Histamine Intolerance

Histamine intolerance results from an imbalance between accumulated histamine and the body's capacity to degrade it, primarily through the enzyme diamine oxidase (DAO) 1. This condition can cause numerous symptoms that mimic allergic reactions, including:

• Gastrointestinal symptoms (diarrhea, abdominal pain)
• Headaches
• Rhinoconjunctival symptoms
• Skin manifestations (urticaria, pruritus, flushing)
• Respiratory symptoms
• Cardiovascular symptoms (hypotension, arrhythmia)

Foods to Avoid in Low Histamine Diets

Apple Cider Vinegar

• Should be avoided in low histamine diets
• All fermented foods are unanimously excluded in low-histamine diets 2
• Vinegars, including apple cider vinegar, undergo fermentation processes that increase histamine content
• The fermentation process creates high levels of histamine through microbial decarboxylation of histidine

Rosemary

• Can be included in low histamine diets
• Not identified as a high histamine food in the scientific literature
• Not listed among commonly excluded foods in low histamine diet protocols 2
• Does not undergo fermentation or aging processes that would increase histamine content

Key Categories of Foods to Avoid

1. Fermented foods (unanimously excluded in all low-histamine diets) 2:

   • Vinegars (including apple cider vinegar)
   • Alcoholic beverages
   • Fermented dairy (aged cheese, yogurt)
   • Fermented vegetables (sauerkraut, kimchi)
   • Fermented soy products

2. High histamine foods:

   • Fish, especially if not fresh
   • Hard cured sausages
   • Aged cheeses 3

3. Histamine-releasing foods (though mechanism not fully elucidated) 2:

   • Certain citrus fruits
   • Some tropical fruits

Effectiveness of Low Histamine Diets

Research shows that low histamine diets can be effective in managing symptoms:

• In a study of 45 patients with food intolerance or chronic headaches, 33 improved considerably after 4 weeks on a histamine-free diet 3
• Eight patients achieved complete remission of symptoms 3

Clinical Management Approach

1. Diagnostic approach:

   • Consider histamine intolerance in patients with recurrent anaphylaxis-like symptoms, especially after consuming histamine-rich foods 4
   • Rule out true IgE-mediated allergies (skin-prick tests and specific IgE to food allergens are typically negative in histamine intolerance) 3

2. Treatment strategy:

   • Implement a low-histamine diet for at least 4 weeks to evaluate effectiveness 5
   • Avoid fermented foods, high-histamine foods, and foods high in putrescine 5
   • Consider second-generation H1 antihistamines for symptom management 5

Cautions and Considerations

• The British Society of Gastroenterology recommends early dietitian involvement to avoid overly restrictive diets 6
• Low-histamine diets vary considerably in their recommendations, with only fermented foods being unanimously excluded 2
• Many self-imposed histamine-restricted diets are unnecessarily restrictive and may impact quality of life without providing long-term benefit 7

Bottom Line

When following a low histamine diet:

• Avoid apple cider vinegar as it is a fermented food with high histamine content
• Rosemary can be included as it is not identified as a high histamine food

An individualized approach with professional guidance is recommended to ensure nutritional adequacy while effectively managing symptoms.