Dr Joneja's Guides to Histamine Intolerance

Dr Janice Joneja, a world expert on histamine intolerance, has published two books on histamine intolerance:

A Beginner's Guide to Histamine Intolerance – read more about it here.

Buy the paperback from Amazon here; buy the e-book from Amazon here.

Histamine Intolerance: The Comprehensive Guide for Healthcare Professionals – read more about it here.

Buy the ebook from Amazon here.

You can buy all of Dr Joneja's books here in the UK or here in the US.

Histamine, IBS and the LEAP (Lifestyle Eating and Performance) program
As part of our on-going histamine Q & A, Dr Janice Joneja was asked whether IBS and seasonal allergies could be set off by a histamine intolerance.


I am a 29 year old female and I have been struggling with IBS symptoms for about 10 years now. I have also developed some other symptoms including dermatologist diagnosed dermatitis, anxiety/mild panic attacks, fast/irregular heartbeat at times, etc. that until now I had no idea that they could be connected. I also have extensive seasonal allergies - I was allergic to every tree, grass and weed that was tested.

I've seen a few different doctors for my stomach issues and have just been told its IBS. I have also been tested for celiacs and have done several different elimination diets over the last 3 years. The only food intolerances I've been able to uncover are dairy (more specifically casein, not just lactose) and possibly corn. Eliminating those two made a difference for a while but in the long run definitely has not solved my issues. I have known for a long time it has to be something hidden in foods because I can eat a food one day and be just fine and eat the same thing the next day and end up feeling miserable.

I recently started working with a dietitian. We've been working off the LEAP diet plan where they did a MRT (mediator release test) for food sensitivities and we were working off the lowest reacting foods while also keeping out dairy and corn. The first time around, I only got worse. I was eating a lot of protein including eggs (and eating leftovers almost every day), eating avocado as a substitute for a lot of foods I couldn't eat- I used it as a sauce, a spread on sandwiches, and made guacamole to go on wraps, etc. I also drank lemon water every single morning. I reacted highly to benzoic acid and sulfides in the MRT test, so I already had those taken out of my diet. When I tried reintroducing other ingredients like cocoa, pineapple and wheat, I also had a reaction. My dietitian reached out to one of her colleagues for some advice since I was only getting worse and she introduced us to the idea of Histamine Intolerance.

Do you think my symptoms match up with histamine intolerance? I'm about a week into a low-histamine diet and am starting to feel better but I have run into a few questions along the way:

I don't see any information on the website about grains. Are brown rice, wheat, oats, etc okay on a low-histamine diet?

I've also seen yeast and "leavening agents" such as baking soda and baking powder listed as high-histamine from some other sources. Can you tell me what you've found on this?

Would you avoid blueberries? I know berries are usually high in bezoates but I haven't seen them on most lists. Are they an exception?

Dr Joneja says:

Thank you for this question.  I am going to take this opportunity to comment on the LEAP program, which is being vigorously promoted to dietitians in the USA, and occasionally appears in Canada and the UK.  It is of great concern to scientists and clinical dietetic practitioners such as myself.  I will follow with answers to your specific questions about histamine intolerance.

Is the LEAP program valid for food sensitivity diagnosis and management?

I have been asked this question many times from dietitians in several countries, especially the United States.  The LEAP (Lifestyle Eating and Performance) program claims to manage a list of conditions, including “IBS, migraine headaches, fibromyalgia, autism, ADD/ADHD, IBD, urticarial, chronic fatigue syndrome, obesity, etc”, that they propose are caused by components of the diet. (Click here to see thier brochure.) The offending foods are identified by a single test and eliminated from the diet.  I have not used the system myself, but have read a great deal of the information provided by the company.  I am very unimpressed by the "science" of the program.  It seems to me to be one more attempt to diagnose reactions that are multifaceted and triggered by different immunological and physiological processes by means of a single test protocol. It would be unrealistic to assume that one test would cover the diversity of responses involved in adverse reactions to foods.  

The basis of the LEAP program is measurement of the release of mediators from granulocytes in blood (mediator release test (MRT). The theory is that if a person is "sensitized" to a food component, granulocytes in their blood will release inflammatory mediators in contact with the sensitizing antigen.  This is similar in effect to the ALCAT test in which similar leukocytes change their morphology or "explode" in contact with their sensitizing antigen. The test detects the change in morphology. The ALCAT test is strongly promoted in some areas.  Unfortunately, again the science is lacking to support its accuracy. The attraction of both LEAP and ALCAT is the apparent simplicity of identifying offending foods in conditions in which we have no other methods of diagnosis. This demonstrates the pressing need for education in the understanding of the processes involved in triggering food-related sensitivities, and a standardized evidence-based method for the determination of each of them.

The LEAP and ALCAT methods of managing a diversity of conditions have been criticised by several medical practitioners as unproven and in some cases risky, as legitimate disease may be overlooked. (See Mullin GE, Swift KM Lipski L, Turnbull LK, Rampertab SD. Testing for food reactions: the good, the bad, and the ugly. Nutr Clin Pract. 2010 Apr;25(2):192-8)

I can thoroughly sympathize with your experience with the LEAP program and the elimination and reintroduction of foods indicated as “allergic” by the MRT.   I have been having very similar experiences with patients - especially from the USA - who have been undergoing these spurious tests, have been advised to avoid long lists of foods for no good reason, and ending up with extreme weight loss, exacerbation of any number of conditions, and - yes - sometimes tipping over into eating disorders.  The test provides a fast and easy way for practitioners to convince their patients and clients that foods are the cause of their multiple problems, and a good income from supervising long and complicated food elimination diets. 
Recently I had a client from Denver who had undergone treatment from an American registered dietitian at a clinic using the Signet Diagnostic Laboratories (who market and promote the LEAP program) for the MRT associated with LEAP.  As a result, the client had lost a considerable amount of weight (down to 95 lbs: she is 5 feet 4 ins) and felt much worse than before.  In addition, the dietitian had sold her a number of food supplements, and several probiotics, all of which were not appropriate for her condition.  I understood that dietitians should not be in the business of selling such products - but perhaps the regulations are different in the US from the way we practice in Canada.  In addition, she will have lost tolerance to a number of the foods she has been avoiding for months on her very bizarre diet resulting from her apparent "reactivity" to so many foods. Reintroduction will be a challenge! Anyone in the field of supervising elimination diets knows from sad experience how it is often difficult to reintroduce foods after long abstinence from them as the body tends to lose tolerance, which needs to be re-established before they can be eaten with impunity.
I sincerely wish we could convince dietitians and other health professionals that there is absolutely no easy way to diagnose food sensitivities, in spite of Naturopaths and other alternative practitioners being convinced otherwise - using often non-evidence- based research. The only reliable way to determine which foods may be involved in a person’s adverse reactions is to eliminate the suspects, based on a clear medical history, valid allergy tests (preferably blood tests for food-specific IgE), and a seven-day food and symptom record. Following a specified period of time (rarely more than 4 weeks) on the elimination diet, depending on the type of elimination diet selected as appropriate (selective elimination diet; few foods elimination diet; elemental diet) each food is reintroduced separately and the patient instructed in monitoring their reactions.  A final nutritionally complete diet is then formulated to avoid the culprit foods and to supply the eliminated nutrients from alternate sources.  There is no short cut to this process.

Now, about histamine intolerance………………..

Histamine intolerance, or sensitivity, refers to the symptoms that develop when the total amount of histamine exceeds the body’s ability to break down the excess to a “normal level”.  The excess histamine is responsible for the symptoms, which resemble allergy. (See my article here.)  Histamine intolerance cannot be diagnosed in the same way as an allergic reaction to food; the latter is usually an immediate response which occurs soon after the offending food is consumed.  Thus, the food responsible can be identified as the person develops symptoms after eating it.  With histamine intolerance the level of histamine increases gradually, building up, often over several hours, until the person’s limit of tolerance (the level above which symptoms appear) is exceeded.  In the meantime, the sensitive individual has consumed many more foods, so is often confused about which ones are actually responsible for their symptoms.  The answer is: usually not any one food, but several with their own load of histamine, like filling up a bucket with water.  When the bucket is full, the water overflows – that is when symptoms develop. 

To answer your specific questions about your possible histamine intolerance:  the symptoms you list certainly suggest that histamine intolerance could be a problem for you.  However, I would need a lot more information to be confident of that diagnosis.  It would certainly be worthwhile for you to follow my histamine restricted diet very closely for 2-4 weeks to see if your symptoms resolve.  If they do, you will need to follow the histamine diet for the long term in order to remain symptom-free.  The fact that you have seasonal allergies further supports the diagnosis of histamine sensitivity as during the season when your allergens are present, the histamine in your body will rise significantly as histamine is released in the allergic reaction.  At these times your “histamine bucket” will already be quite full and just a few histamine-associated foods will overflow the bucket and put you into your symptom range.

In answer to your specific questions about the diet:

All pure grains are allowed, as long as you are not allergic to them.  You have identified corn as problematic, so you would need to continue to avoid it. (See my article on corn allergy here.)  Of the rest, only those with additional ingredients, such as processed grains in manufactured foods with additives, are not safe.

Yeast enzymes act on sugars to form carbon dioxide and alcohol.  The bubbles of CO2 within the dough cause the bread or other bakery product to rise.  Similarly, chemical leavening agents such as baking soda (sodium bicarbonate) and baking powder cause dough to rise by releasing carbon dioxide when mixed with water.  The gas bubbles of CO2 within the dough cause the “rising”.  No histamine is involved in the process. So yeast-containing products and leavened breads are quite safe on a histamine-restricted diet. 

Berries tend to contain varying levels of benzoates that in certain people trigger the release of histamine.  The highest levels of benzoates in berries are found in strawberries, raspberries and cranberries.  Blueberries have very little benzoate so are probably safe for most histamine-sensitive people.

May 2015

If you found this article interesting you can find a number of other articles on histamine intolerance both by Dr Joneja and others here, reports on histamine research here and a Q & A section on histamine with Dr Joneja here.

For many, many other articles on every type of food allergy and intolerance click here; for coeliac disease and other food related conditions, go here.

Dr Janice Joneja, Ph.D., RDDr. Janice Joneja is a researcher, educator, author, and clinical counsellor with over thirty years of experience in the area of biochemical and immunological reactions involved in food allergy and intolerances. Dr. Joneja holds a Ph.D. in medical microbiology and immunology and was a registered dietitian (RD) – now retired. 

She has been a member of the faculty at several Canadian universities, starting her career as an Assistant Professor in the Department of Microbiology, Faculty of Science, and in the Faculty of Dentistry, at the University of British Columbia, Vancouver. Since 2001 Dr. Joneja has been a faculty member in the School of Biomedical and Molecular Sciences, at the University of Surrey, in England, teaching in the M.Sc. course in Nutritional Medicine.  For 12 years she was head of the Allergy Nutrition Program at the Vancouver Hospital and Health Sciences Centre.

Dr. Joneja is the author of six books and a dietetic practice manual on food allergy, a textbook on Irritable Bowel Syndrome, and several distance education courses. Her most recent books include “The Health Professional’s Guide to Food Allergies and Intolerances”, “Dealing with Food Allergies”, and “Dealing with Food Allergies in Babies and Children”.  Dr. Joneja’s work has been published in peer-reviewed scientific and medical journals, as well as in popular magazines.  She is a respected lecturer at universities, colleges and hospitals internationally, and regularly appears on television and radio call-in shows as an expert in her field.

Dr. Joneja is President of Vickerstaff Health Services, Inc., a practice that provides counselling for people suffering from all aspects of adverse reactions to food, and resources for the professionals and care-givers who support them.

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