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SIGHI Elimination Diet Protocol

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SIGHI Elimination Diet Protocol

Source: SIGHI Leaflet “Histamine Elimination Diet” (2021-11-17) and Food Compatibility List instructions.

Two Levels of Diet

SIGHI distinguishes between two populations:

Simplified elimination diet — for people with a DAO degradation disorder (histamine intolerance in the strict sense). Avoids histamine, other biogenic amines, and DAO inhibitors in food. Uses the simplified leaflet.

Detailed elimination diet — for people with mast cell activation disorders (MCAS/mastocytosis). The simplified diet is NOT sufficient for MCAS. The detailed list additionally accounts for histamine liberators as completely as possible. This is the full food compatibility list.

If the simplified diet doesn’t achieve permanent symptom relief, suspect MCAS and switch to the detailed list.

Protocol Phases

Phase 1: Strict elimination (4-6 weeks) Follow the compatibility list as consistently as possible. Goal is to reduce symptom intensity quickly and establish a baseline of low reactivity.

Phase 2: Systematic reintroduction After 4-6 weeks, begin testing what you can tolerate in what quantities based on individual sensitivity. This is where the Confidente app’s experimental design methodology becomes valuable — structured reintroduction with controlled variables rather than ad hoc testing.

Phase 3: Personalized long-term diet In the long term, don’t follow any list — follow your own experience. Everything is allowed as long as it’s well tolerated. The list is a starting tool, not a permanent restriction.

Why Confidente Matters Here

The SIGHI protocol acknowledges that the transition from Phase 1 to Phase 2 is where people get stuck. Their guidance is essentially “try things and see what happens” — which is exactly the problem Confidente solves with:

  • Structured Latin square-inspired meal plans for reintroduction
  • Confounder tracking (the SIGHI docs note that stress, hormones, weather, and many non-food triggers confound results)
  • Statistical correlation to surface patterns that are hard to notice subjectively
  • Washout windows to prevent cumulative effects from masking results

Five Mechanisms of Food Triggers

The SIGHI leaflet identifies five distinct mechanisms. This maps directly to our Sensitivity Categories:

1. Histamine-containing foods — histamine formed as a spoilage product, in fermentation/maturation, and in fruit ripening. Some vegetables are naturally high even when fresh.

  • Medication: DAOSIN (15-30 min before meal), H1 antihistamines, possibly H2 antihistamines

2. Other biogenic amines — putrescine, cadaverine, tyramine, etc. These compete with histamine for DAO degradation. While DAO is busy with other amines, histamine breakdown is blocked. Some amines also cause histamine-like symptoms directly.

  • Key foods: pineapple, banana, pears, peanuts, grapefruit, raspberries, legumes, kiwi, oranges, papaya, wheat germ
  • Medication: H1 antihistamines, DAOSIN

3. Histamine liberators — foods that trigger endogenous histamine release from mast cells. Independent of DAO. Enhanced in MCAS.

  • Key foods: alcohol, strawberries, walnuts/cashews, seafood/shellfish, chocolate/cocoa, tomatoes, citrus fruits
  • Medication: H1 antihistamines, cromoglicic acid, ibuprofen
  • DAOSIN has NO effect against liberators

4. DAO inhibitors — chemicals that block DAO enzyme activity, slowing histamine breakdown.

  • Key substances: alcohol/acetaldehyde, certain biogenic amines, certain medications, theobromine, mate tea
  • Medication: H1 antihistamines
  • DAOSIN is ineffective against DAO inhibitors

5. Increased intestinal permeability — substances that make the gut leaky, allowing macromolecules to enter the body.

  • Key substances: alcohol (increases allergen uptake), hot spices (increase intestinal permeability for histamine)
  • Medication: mast cell stabilizers (continuous), H1 antihistamines
  • DAOSIN has no effect here

Implication for the App

The fact that DAOSIN only works for mechanisms 1 and 2 (dietary histamine and competing amines) but NOT for liberators, DAO inhibitors, or permeability issues is critical for the app’s hypothesis engine. If a user reports symptoms from known liberator foods but not from high-histamine foods, suggesting DAO supplements would be wrong. The mechanism classification in the seed data enables this reasoning.

Key Freshness Rules from SIGHI

  • The more perishable and protein-rich, the more important freshness is
  • Uninterrupted cold chain from producer to consumer
  • Never leave perishables unrefrigerated, not even briefly
  • Let leftovers cool briefly then freeze immediately
  • Thaw quickly and consume immediately
  • “May contain traces of…” labels are NOT relevant for HIT/MCAS (only for true allergies)

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