Histamine and ferments
Histamine forms during fermentation, and the body nearly always clears it without trouble. When it doesn't, how much each ferment carries and what science knows about intolerance.
6 min read Getting good Reviewed October 27, 2026 30 facts, each with its source
What histamine is
Histamine is one of the biogenic amines, molecules that bacteria make from amino acids during fermentation1. It can build up in fish and meat that aren't fresh or weren't stored well, and in fermented foods2, from aged cheese to sauerkraut.
In the amounts normal food carries, it doesn't make you ill, because enzymes in the gut break it down3. The main one is DAO, which acts as a barrier against histamine from food4.
When it's too much
If you eat a lot of it, or those enzymes work poorly, symptoms appear that resemble an allergy: nausea, trouble breathing, flushing, sweating, palpitations, headache, burning in the mouth, diarrhea or changes in blood pressure, which in severe cases become sharp rises5.
It doesn't affect everyone the same way. It depends on the person, on alcohol and on some medicines6:
- Alcohol increases histamine's effect7. Wine with a fermented dish adds up.
- Some drugs inhibit DAO, and about 20% of Europeans are estimated to take them regularly8.
- MAOIs, a kind of medicine for anxiety or depression, make the people who take them more sensitive to the amines in fermented foods9. With them, the main worry isn't histamine but tyramine, which can raise blood pressure10. Up to 206 mg/kg of tyramine has been reported in sauerkraut, within the range that has caused symptoms11.
Histamine intolerance
Histamine intolerance is difficulty breaking histamine down in the gut because DAO doesn't work well12. The same foods that bother someone with intolerance don't cause those reactions in other people13.
Science is still pinning it down:
- There's no consensus on how to diagnose it14. Other causes of the symptoms, such as an allergy, have to be ruled out first15, and some proposed tests haven't been validated16.
- The main approach is a low-histamine diet17, but there's no agreement on which foods to avoid18. In a review of ten such diets, each excluded different things. The only thing all of them excluded was fermented foods19.
How much a ferment carries
For a healthy person, FAO and WHO, assessing fish poisoning, set the no-effect dose at 50 mg of histamine in a meal: at that level there shouldn't be symptoms20. For someone with intolerance, the figure is lower and unknown.
| Ferment | Reported histamine | In 100 g (3.5 oz) |
|---|---|---|
| Sauerkraut | Up to 37 mg/kg, the highest reported21 | About 3.7 mg |
| Kimchi | Up to 947 mg/kg, the highest reported22 | About 95 mg |
The right-hand column is Fervida's arithmetic: the highest reported levels, per 100 g. They aren't typical. In Spain, fermented foods on the market average between 22 and 74 mg/kg, although some samples go much higher23. It varies so much that it changes even within a single batch24.
Kimchi's difference comes partly from fish: fermented fish sauces and pastes add histamine25. Fervida's kimchi is vegetables only.
What you can do at home
Amines can form early on, before lactic acid bacteria have taken over26. So what helps is the same as what makes a good ferment: the right time, temperature, salt and storage, with good ingredients27.
- Salt right away after cutting28, with the recipe's weighed salt.
- Use fresh vegetables and leave out fermented fish if you want less histamine.
- Ferment at the recipe's temperature and move it to the fridge when it's done: below 5 °C (41 °F), fewer amines form29.
None of this makes a ferment suitable for someone with intolerance. It only avoids adding more than necessary.
When to talk to your doctor
If fermented foods, aged cheese or wine often give you headaches, itching, flushing or digestive trouble, talk to your doctor before changing your diet. Other causes have to be ruled out first15, and an exclusion diet on your own can cut out far more than needed: in the review of those ten diets, only 32% of the excluded foods carried enough histamine to justify it30.
Talk to them too if you take any medicine that may inhibit DAO. And if you take an MAOI, don't start eating fermented foods without asking first, because of tyramine10. And if you already know you have intolerance, ask your doctor before trying any ferment.
Where every number comes from
Every number in the text leads to its figure: the exact sentence from the official guide it comes from, in its own language.
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1
Biogenic amines form through bacterial action during fermentation
“Biogenic amines (BAs) are low-molecular weight bacterial decarboxylation products of amino acids formed during fermentation.”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 2: Starter cultures and fermented food standards (August 2024, updated December 2024) · read on October 25, 2026
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2
It can build up in fish and meat that aren't fresh, and in fermented foods
“Foods that potentially contain high levels of histamine are: a) those microbiologically altered, such as fish and meat, or derived products that may have been preserved or processed in unsuitably hygienic conditions; and b) fermented products”
Biomolecules (MDPI), Comas-Basté et al. · Histamine intolerance: the current state of the art (2020) · read on October 26, 2026
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3
In normal amounts they don't make you ill: gut enzymes break them down
“Normal BA intake does not cause illness as intestinal amine oxidases break down and detoxify the BAs.”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 3.2: Sauerkraut (2024) · read on October 26, 2026
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4
The DAO enzyme is the main defense against histamine from food
“the more highly expressed DAO plays the major role in protecting the body against exogenous histamine, whether originating from ingested food or generated by the intestinal microbiota”
Biomolecules (MDPI), Comas-Basté et al. · Histamine intolerance: the current state of the art (2020) · read on October 26, 2026
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5
In excess, symptoms that resemble an allergy
“BA-associated adverse health effects mimic allergic reaction and range in potential severity, including nausea, respiratory distress, hot flush, sweating, heart palpitations, headache, bright red rash, burning sensations in the mouth, alterations in blood pressure, diarrhea and hypertensive crises.”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 2: Starter cultures and fermented food standards (August 2024, updated December 2024) · read on October 25, 2026
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6
Effects vary with each person, with alcohol and with MAOIs
“The toxic effects of BA may vary between individuals as it depends on individual sensitivity and on the consumption of alcohol or drugs that are monoaminooxidase inhibitory (MAOI).”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 2: Starter cultures and fermented food standards (August 2024, updated December 2024) · read on October 25, 2026
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7
Alcohol increases histamine's toxic effect
“However, it must be noted that the presence of alcohol will enhance the toxic effect of histamine”
Nutrients (MDPI), Sánchez-Pérez et al. · Low-histamine diets: is the exclusion of foods justified by their histamine content? (2021) · read on October 26, 2026
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8
About 20% of Europeans regularly take drugs that inhibit DAO
“It has been estimated that approximately 20% of the European population regularly take DAO-inhibiting drugs, which significantly increases the number of people susceptible to the adverse effects of dietary histamine”
Biomolecules (MDPI), Comas-Basté et al. · Histamine intolerance: the current state of the art (2020) · read on October 26, 2026
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9
People on MAOIs, for anxiety or depression, are more sensitive to amines
“Persons prescribed MAOI drugs (e.g., for anxiety or depression) have increased sensitivity to BAs in fermented foods”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 2: Starter cultures and fermented food standards (August 2024, updated December 2024) · read on October 25, 2026
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10
Tyramine matters for its toxicity and because, with an MAOI, it can raise blood pressure
“Dietary exposure to tyramine is very important due to its toxicity and potential interaction with MAOIs that can raise blood pressure.”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 2: Starter cultures and fermented food standards (August 2024, updated December 2024) · read on October 25, 2026
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11
Up to 206 mg/kg of tyramine has been reported in sauerkraut, in the range that has caused symptoms
“of tyramine were 206 mg/kg (within reported levels that cause illness between 100 and 800 mg/kg)”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 3.2: Sauerkraut (2024) · read on October 26, 2026
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12
Intolerance: the gut breaks down histamine poorly because DAO falls short
“Histamine intolerance, also referred to as enteral histaminosis or sensitivity to dietary histamine, can be defined as a disorder arising from reduced histamine degradation capacity in the intestine due to impaired DAO activity”
Biomolecules (MDPI), Comas-Basté et al. · Histamine intolerance: the current state of the art (2020) · read on October 26, 2026
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13
The same foods don't cause those reactions in others
“The same histamine-rich foods would not cause these reactions in a non-susceptible population.”
FAO and WHO · Public health risks of histamine and other biogenic amines from fish and fishery products: meeting report (2013) · read on October 26, 2026
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14
There's no consensus on how to diagnose it
“Despite significant advances in the understanding of histamine intolerance, reaching a consensus on a diagnostic algorithm remains a pending challenge.”
Biomolecules (MDPI), Comas-Basté et al. · Histamine intolerance: the current state of the art (2020) · read on October 26, 2026
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15
Other causes have to be ruled out first
“All the authors who have proposed a diagnostic algorithm for histamine intolerance emphasize the need to initially rule out other potential causes of symptoms associated with an increase in plasma histamine”
Biomolecules (MDPI), Comas-Basté et al. · Histamine intolerance: the current state of the art (2020) · read on October 26, 2026
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16
Unvalidated tests have been proposed
“A range of nonvalidated complementary tests have also been proposed by several authors with the aim of obtaining a marker to confirm the diagnosis”
Biomolecules (MDPI), Comas-Basté et al. · Histamine intolerance: the current state of the art (2020) · read on October 26, 2026
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17
The main approach is a low-histamine diet
“Currently, the main strategy to avoid the symptoms of histamine intolerance is to follow a low-histamine diet.”
Biomolecules (MDPI), Comas-Basté et al. · Histamine intolerance: the current state of the art (2020) · read on October 26, 2026
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18
There's no agreement on which foods to avoid
“there is still a lack of consensus on the foods that must be avoided in the dietary management of histamine intolerance.”
Nutrients (MDPI), Sánchez-Pérez et al. · Low-histamine diets: is the exclusion of foods justified by their histamine content? (2021) · read on October 26, 2026
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19
Every low-histamine diet excludes fermented foods
“Only fermented foods were unanimously excluded.”
Nutrients (MDPI), Sánchez-Pérez et al. · Low-histamine diets: is the exclusion of foods justified by their histamine content? (2021) · read on October 26, 2026
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20
At 50 mg of histamine, a healthy person shouldn't have symptoms
“The hazard characterization concluded that a dose of 50 mg of histamine, which is the no-observed-adverse-effect level (NOAEL), is the appropriate hazard level. At this level healthy individuals would not be expected to suffer any of the symptoms associated with SFP.”
FAO and WHO · Public health risks of histamine and other biogenic amines from fish and fishery products: meeting report (2013) · read on October 26, 2026
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21
The highest reported level in sauerkraut, 37 mg/kg
“The highest levels of histamine reported for sauerkraut were 37 mg/kg (below the illness threshold of 100 mg/kg)”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 3.2: Sauerkraut (2024) · read on October 26, 2026
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22
The highest reported level in kimchi, 947 mg/kg
“The highest levels of histamine reported for kimchi were 947.3 mg/kg (exceeding the illness threshold of 100 mg/kg)”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 3.3: Kimchi (2024) · read on October 26, 2026
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23
In Spain, fermented foods average 22–74 mg/kg, with some very high samples
“histamine levels in fermented foods marketed in Spain were relatively low (with mean values ranging between 22 and 74 mg/kg), but in certain cases these types of foods reached high histamine levels”
Nutrients (MDPI), Sánchez-Pérez et al. · Low-histamine diets: is the exclusion of foods justified by their histamine content? (2021) · read on October 26, 2026
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24
It varies a lot, even within one batch
“Contrarily, fermented foods had a large variability, even within samples of the same production batch due to the essentially microbial origin of histamine.”
Nutrients (MDPI), Sánchez-Pérez et al. · Low-histamine diets: is the exclusion of foods justified by their histamine content? (2021) · read on October 26, 2026
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25
Fish sauces and pastes add histamine to kimchi
“Jeotgal and Aekjetot were found in one study to contribute to the production of histamine and tyramine in kimchi.”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 3.3: Kimchi (2024) · read on October 26, 2026
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26
Amines can form early, before lactic acid bacteria take over
“Biogenic amines produced by aerobic microbes may form during initial stages of fermentation before LAB can grow.”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 3.2: Sauerkraut (2024) · read on October 26, 2026
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27
They're controlled through time, temperature, salt, storage and good ingredients
“optimizing the fermentation: regulating time, temperature, moisture content, salt concentrations, and storage conditions; using good quality ingredients;”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 3.2: Sauerkraut (2024) · read on October 26, 2026
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28
Salt right after cutting
“Following slicing and shredding it is important to add salt quickly to promote LAB growth”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 3.2: Sauerkraut (2024) · read on October 26, 2026
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29
Below 5 °C (41 °F), fewer amines form
“Formation of biogenic amines is reduced beneath 5°C or over 40°C.”
BC Centre for Disease Control, Environmental Health Services · Safety of Fermented Foods, Section 2: Starter cultures and fermented food standards (August 2024, updated December 2024) · read on October 25, 2026
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30
Only 32% of excluded foods are justified by their histamine
“The critical review performed herein demonstrates that the exclusion of only 32% of foods could be justified by their histamine content.”
Nutrients (MDPI), Sánchez-Pérez et al. · Low-histamine diets: is the exclusion of foods justified by their histamine content? (2021) · read on October 26, 2026