Rebelytics Low Nickel Diet Scoring System

I just want to know what to eat! Take me to the Score Sheets!

I was looking for the Nickel Navigator app for Android.

People who have a nickel allergy can have a systemic reaction to the nickel naturally present in food. This reaction, known as Systemic Nickel Allergy Syndrome (SNAS), most often involves dermatological symptoms as well as headache, gastrointestinal and respiratory symptoms [Ricciardi2014, Calogiurui2016, Tammaro2011, Minelli2010, Schiavino2006] and other symptoms consistent with fibromyalgia syndrome [Goldenberg2015]. Nickel hypersensitivity has also been implicated in fibromyalgia, chronic fatigue, and other chronic diseases through the corrosion of dental metals [Sterzl1999, Lindh2002, Muris2006, Sjursen2011, Stejskal2013, Stejskal2014], where the combined oral intake from dental metals and diet can lead to a systemic immune hypersensitivity reaction.


Following a diet low in nickel can improve these symptoms, but can be challenging. First, there is a lot of conflicting advice regarding the nickel content of foods [Pizzutelli2011]. This may be due to the natural variations in nickel content caused by the nickel content of the soil where they were grown, how a sample was processed, or how a food sample was cooked. Second, keeping track of one's nickel intake is a chore. It is not easy to compute how much nickel is in a serving of a food because nickel concentrations are traditionally reported in mg/kg. Also, counting micrograms, like counting calories, is not a sustainable diet plan.


To address the ease of use issue, American doctors Dr. Mislankar and Dr. Zirwas proposed a simple "Low-Nickel Diet Scoring System" using data from the United States FDA [Mislankar2013]. In this system, nickel concentration [Ni] is converted from mg/kg to µg/serving by using the FDA approved serving sizes, doubled since actual portion sizes have been increasing in the United States [Young2002]. A food is assigned 0 points if it has less than 1 µg/serving, 1 point if 1 ≤ [Ni] < 10 µg/serving, 2 points if 10 ≤ [Ni] < 20 µg/serving, and so on up to 10 points if 90 ≤ [Ni] < 100 µg/serving. Foods with more than 100 µg/serving are to be avoided entirely, and nickel consumption is limited to 15 points or 150 µg/day.


In our extension of the low nickel diet scoring system, we use a collection of nickel content data from many sources around the world (over 70 sources to date, including national studies and research papers) to compute a weighted average so that the most geographically relevant samples are given priority. This reflects the potential local variations in food sources, manufacturing and food preparation methods. We use Health Canada's serving sizes to get the nickel per serving, and the points are assigned as in [Mislankar2013]. The food scores are presented on colour-coded Score Sheets using a traffic light system (green, yellow, red) to make the low (1 point), moderate (2 points) and high (3 or more points) nickel foods easy to recognize.

Score Sheets

Score Sheets have been made for various locations around the world, and one from a global perspective (where the data isn’t weighted by location). Choose the Score Sheet for the location closest to you. All of the sheets are also available within the Excel workbook so that you can customize them if you feel so inclined. Don't forget to sign up for update notifications.


NOTE: This diet is intended for individuals with a diagnosed nickel allergy. If you have not been patch tested or had a blood test to diagnose your nickel allergy, please do so before starting this diet. It is not a weight loss diet and must not be entered into lightly.



The goal is to limit your daily points to 15. Pay close attention to serving sizes. We recommend using a kitchen scale until you get used to estimating serving sizes. In the Score Sheets, blue foods are essentially free, green foods cost 1 point, yellow foods 2 points, and red foods 3 or more points. You're more likely to win (eat more) if you stick to the blue and green foods. Red foods should typically be avoided to increase the variety of food that you eat and maximize the nutrition your body needs to heal. Aim to get at least 5 servings of fruits and vegetables each day! After 4-6 months, try to slowly reintroduce moderate nickel foods.


An asterisk (*) beside a food's label means that there is only one measurement available for this food. Be suspicious of these because there is often a wide variation in nickel content and this single measurement could be on the very low or very high side of the average. Beside the average score, the range of scores is given in brackets to give you an indication of how high a score can get, but be aware that the likelihood of a sample having the highest value is generally small. If you want to have a better look at the statistics for a food, look it up in the summary tables. See Nickel in Foods for an analysis of the trends in nickel content by food group.

Cooking Equipment

Cooking methods can make a difference to the amount of nickel in the finished product. Nickel is leached from some stainless steel [Kuligowski1992, Kamerud2013, Bassioni2015] and aluminum [Lomolino2016, Papuc2017] cookware in amounts significant to those who are sensitized. There are also reports of ceramic pans leaching nickel [Lomolino2016, Papuc2017]. Acidity, heat and exposure time all contribute to the amount of nickel that leaches out. For baking and cooking in the oven, glass is probably the safest option. Parchment paper can be used to line existing pans (which also makes for easier clean-up). For recipes that normally wrap foods in aluminum foil, parchment paper can be creatively applied.


Look for "18/0" stainless steel cutlery (the 0 indicates the nickel content). Ceramic kitchen knives are also available, although they are not as durable as steel. In a pinch, plastic cutlery will do.


To minimize the nickel content in coffee, water can be boiled in a Pyrex measuring cup in a microwave, and the coffee made with a metal-free coffee maker such as the AeroPress. Similarly, water for tea can be microwaved in a mug (or the water and teabag heated simultaneously) instead of heated in a kettle .

Other Considerations

To speed up the healing process, you'll want to deal with all other sources of inflammation, including foods to which you have experienced sensitivities in the past. If a food is low in nickel according to the data but your gut tells you it's a problem (maybe literally), exclude it from your diet. After you have improved, try reintroducing these foods and the moderate nickel foods that you've been missing, one at a time and very slowly. Use a food journal to track your response.


Histamine intolerance [Maintz2007] is known to be an issue for some SNAS sufferers, and some low-nickel foods are naturally high in histamine. A low histamine diet can be very helpful. It should be noted that there is a substantial amount if variation in the histamine content of foods and in the recommendations of various low-histamine diets [SanMauroMartin2016], and not all histamine-inducing foods affect everyone in the same way, so some trial and error will be needed.


Sweating is an excellent way to rid the body of excess nickel [Hohnadel1973]. Sweat also contains histamine and various immunoglobulins [Forstrom1975]. Saunas, hot baths and exercise will increase sweat production. It is important to wash the sweat off so that the skin doesn't react to the nickel.


It is common for multiple allergies to coexist with a nickel allergy. Nickel allergies have been found to coexist with another metal 40% of the time; palladium, cobalt and gold were most often paired with nickel [Tu2011]. If you haven't had a complete set of metal allergy testing (patch tests or blood tests), consult your doctor. Allergies to chemicals such as methylisothiazolinone and formaldehyde have also been observed, anecdotally.


Nickel is a common element in dental alloys, and is always present in trace amounts, even when they are labelled nickel-free [Ortiz2011]. Dental metals are a continuous oral source of nickel through galvanic corrosion, particularly when metals with different properties coexist [Nogi1989, Anusavice2012, Ciszewski2007, Taher2003, Lee2015]. Pairing nickel with titanium nearly doubles the corrosion rate [Taher2003, Lee2015]. Corrosion can increase with surface area and pitting [Zohdi2012], and saliva properties [Nogi1989, Zohdi2012], and flouride can impair the corrosion resistance of some alloys [Zohdi2012].


Probiotics have been shown to be beneficial for the healing of the gut and skin. L. reuteri was helpful in the treatment of SNAS [Randazzo2014], and a combination of L. reuteri and L. rhamnosus improved atopic dermatitis in another study [Rosenfeldt2003]. Some probiotic strains raise or lower histamine levels; more research is needed in this area.


Dietary supplements have been shown to be a hidden source of nickel [VanDerVoet2008, Li2015, PonceDeLeon2002, Adolfo2016, Avula2010]. Although iron is said to interfere with nickel uptake, the supplements themselves contain high levels of nickel [Cardoso2017, Li2015] and accidental overdose is easy and very dangerous. Only take iron supplements if you have been instructed to do so by a medical professional. In one study, vitamin A supplementation was shown to lower blood levels of nickel [Patar2011], but vitamin A toxicity can cause liver damage so care should be taken not to exceed established safety limits. Where practical, choose food sources of nutrients over supplements. The exception is vitamin C, which reduces the uptake of nickel when taken with food [Solomons1982].


Following a low nickel diet is challenging, but is worthwhile for SNAS. In one large study, 80% of patients on a low nickel diet for 4 weeks had a complete or near-complete recovery from dermatitis symptoms [Antico2015]. In a smaller study focussing on gatrointestinal symptoms, patients on a low nickel diet for 3 months showed a significant decrease in symtpoms [Rizzi2017].


If you're on Facebook, the Low Nickel Diet - Eating Well with Nickel Allergy/SNAS group is a good support system. Other helpful SNAS advice can be found at The Reluctant Health Nut. If you're suffering from ACD to nickel or any other contact allergens, the Dermatitis Academy is a good educational resource, created and maintained by doctors and medical researchers.


F.R. Adolfo, P.C. do Nascimento, D. Bohrer, L.M. de Carvalho, C. Viana, A. Guarda, A.N. Colim and P. Mattiazzi, Simultaneous determination of cobalt and nickel in vitamin B12 samples using high-resolution continuum source atomic absorption spectrometry, Talanta 147 (2016): 241-245.
A. Antico and R. Soana, Nickel sensitization and dietary nickel are a substantial cause of symptoms provocation in patients with chronic allergic-like dermatitis syndromes, Allergy and Rhinology 6 no. 1 (2015): e56–e63.
K.J. Anusavice and W.A. Brantley, Physical Properties of Dental Materials, Chapter 3, In: K.J. Anusavice, C. Shen and H.R. Rawls, Phillips' Science of Dental Materials, Elsevier Health Sciences, 2012.
G. Bassioni, A. Korin, and A.E.D. Salama, Stainless steel as a source of potential hazard due to metal leaching into beverages, International Journal of Electrochem. Science 10 (2015): 3792-3802.
G.F. Calogiuri, D. Bonamonte, C. Foti and S. Al-Sowaidi, Nickel Hypersensitivity: A General Review on Clinical Aspects and Potential Co-Morbidities. Journal of Allergy and Therapy 7 (2016): 243.
P. Cardoso, P. Amaro, J.P. Santos, J.T. de Assis and M.L. Carvalho, Determination of Nickel and Manganese Contaminants in Pharmaceutical Iron Supplements Using Energy Dispersive X-ray Fluorescence, Applied Spectroscopy 71 no.3 (2017) 432-437.
A. Ciszewski, M. Baraniak and M. Urbanek-Brychczyńska, Corrosion by galvanic coupling between amalgam and different chromium-based alloys, Dental Materials 23, no. 10 (2007): 1256-1261.
L. Förström, M.E. Goldyne and R.K. Winkelmann, IgE in human eccrine sweat, Journal of Investigative Dermatology 64 no. 3 (1975): 156-157.
A. Goldenberg and S.E. Jacob, Update on systemic nickel allergy syndrome and diet, European Annals of Allergy and Clinical Immunology 47 no. 1 (2015): 25-26.
D.C. Hohnadel, F.W. Sunderman, M.W. Nechay and M.D. McNeely, Atomic absorption spectrometry of nickel, copper, zinc, and lead in sweat collected from healthy subjects during sauna bathing, Clinical Chemistry 19 no. 11 (1973): 1288-1292.
K.L. Kamerud, K.A. Hobbie, and K.A. Anderson, Stainless Steel Leaches Nickel and Chromium into Foods During Cooking, Journal of Agricultural and Food Chemistry 61 no. 39 (2013): 9495–9501.
J. Kuligowski and K.M. Halperin, Stainless steel cookware as a significant source of nickel, chromium, and iron, Archives of Environmental Contamination and Toxicology 23 no.2 (1992): 211-215.
J. Lee, K. Song, S. Ahn, J. Choi, J. Seo and J. Park, Evaluation of effect of galvanic corrosion between nickel-chromium metal and titanium on ion release and cell toxicity, The Journal of Advanced Prosthodontics 7, no. 2 (2015): 172-177.
G. Li, D. Schoneker, K.L. Ulman, J.J. Sturm, L.M. Thackery and J.F. Kauffman, Elemental impurities in pharmaceutical excipients, Journal of Pharmaceutical Sciences 104 no. 12 (2015): 4197-4206.
G. Lomolino, A. Crapisi and M. Cagnin, Study of elements concentrations of European seabass (Dicentrarchus labrax) fillets after cooking on steel, cast iron, teflon, aluminum and ceramic pots, International Journal of Gastronomy and Food Science 5 (2016): 1-9.
L. Maintz and N. Novak, Histamine and histamine intolerance, The American Journal of Clinical Nutrition 85 no. 5 (2007): 1185-1196.
M. Minelli, D. Schiavino, F. Musca, M.E. Bruno, P. Falagiani, G. Mistrello, G. Riva, M. Braga, M.C. Turi, V. Di Rienzo and C. Petrarca, Oral hyposensitization to nickel induces clinical improvement and a decrease in TH1 and TH2 cytokines in patients with systemic nickel allergy syndrome, International Journal of Immunopathology and Pharmacology 23 no. 1 (2010):193-201.
M. Mislankar and M.J. Zirwas, Low-nickel diet scoring system for systemic nickel allergy, Dermatitis 24 no. 4 (2013): 190-195.
N. Nogi, [Electric current around dental metals as a factor producing allergenic metal ions in the oral cavity], The Japanese Journal of Dermatology 99 no. 12 (1989): 1243-1254.
A.J. Ortiz, E. Fernández, A. Vicente, J.L. Calvo, and C. Ortiz, Metallic ions released from stainless steel, nickel-free, and titanium orthodontic alloys: toxicity and DNA damage, American Journal of Orthodontics and Dentofacial Orthopedics 140 no. 3 (2011): e115-e122.
C. Papuc, I. Chera, C. Predescu, V. Nicorescu, I. Gajaila and G.V. Goran, The Influence of Cookware on the Concentration of Trace Metals and Lipid Peroxidation in Pork Muscle, Revista de Chimie 68 no. 7 (2017): 1476-1480.
S. Patlar, E. Boyali, A.K. Baltaci and R. Mogulkoc, The effect of vitamin A supplementation on various elements in elite taekwondo players, Biological Trace Element Research 139 no. 3 (2011): 296-300.
S. Pizzutelli, Systemic nickel hypersensitivity and diet: myth or reality?, European Annals of Allergy and Clinical Immunology 43 no. 1 (2011): 5.
C.A. Ponce de León, M.M. Bayón and J.A. Caruso, Trace element determination in vitamin E using ICP-MS, Analytical and Bioanalytical Chemistry 374 no. 2 (2002): 230-234.
C.L. Randazzo, A. Pino, L. Ricciardi, C. Romano, D. Comito, E. Arena, S. Saitta and C. Caggia, Probiotic supplementation in systemic nickel allergy syndrome patients: study of its effects on lactic acid bacteria population and on clinical symptoms, Journal of Applied Microbiology 118 no. 1 (2105): 202-211.
L. Ricciardi, A. Arena, E. Arena, M. Zambito, A. Ingrassia, G. Valenti, G. Loschiavo, A. D'Angelo and S. Saitta, Systemic nickel allergy syndrome: epidemiological data from four Italian allergy units, International Journal of Immunopathology and Pharmacology 27 no. 1 (2014): 131-136.
A. Rizzi, E. Nucera, L. Laterza, E. Gaetani, V. Valenza, G.M. Corbo, R. Inchingolo, A. Buonomo, D. Schiavino and A. Gasbarrini, Irritable Bowel Syndrome and Nickel Allergy: What Is the Role of the Low Nickel Diet?, Journal of Neurogastroenterology and Motility 23 no. 1 (2017): 101–108.
V. Rosenfeldt, E. Benfeldt, S.D. Nielsen, K.F. Michaelsen, D.L. Jeppesen, N.H. Valerius and A. Paerregaard, Effect of probiotic Lactobacillus strains in children with atopic dermatitis, Journal of Allergy and Clinical Immunology, 111 no. 2 (2003): 389-395.
I. San Mauro Martin, S. Brachero and E.G. Vilar, Histamine intolerance and dietary management: A complete review, Allergologia et Immunopathologia 44 no. 5 (2016): 475-483.
D. Schiavino, E. Nucera, C. Alonzi, A. Buonomo, E. Pollastrini, C. Roncallo, T. De Pasquale, C. Lombardo, G. La Torre, V. Sabato and V. Pecora, A clinical trial of oral hyposensitization in systemic allergy to nickel, International Journal of Immunopathology and Pharmacology 19 no. 3 (2006): 593-600.
N.M. Taher and A.S. Al Jabab, Galvanic corrosion behavior of implant suprastructure dental alloys, Dental Materials 19 no. 1 (2003): 54-59.
A. Tammaro, A. Narcisi, S. Persechino, C. Caperchi and A. Gaspari, Topical and systemic therapies for nickel allergy, Dermatitis 22 no. 5 (2011): 251-255.
M.E. Tu and Y.H. Wu, Multiple allergies to metal alloys, Dermatologica Sinica 29 no. 2 (2011): 41-43.
G. B. van der Voet, A. Sarafanov, T.I. Todorov, J.A. Centeno, W.B. Jonas, J.A. Ives and F.G. Mullick, Clinical and analytical toxicology of dietary supplements: a case study and a review of the literature, Biological Trace Element Research 125 no. 1 (2008): 1-12.
L.R. Young and M. Nestle, The Contribution of Expanding Portion Sizes to the US Obesity Epidemic, American Journal of Public Health 92 no. 2 (2002): 246-249.
H. Zohdi, M. Emami and H.R. Shahverdi, Galvanic corrosion behavior of dental alloys, Substance 4 (2012): 6.

Appendix: Generating a Custom Score Sheet

The Excel workbook contains macros that generate Score Sheets based on location. The first sheet contains notes and information on how to use it. The "Main" sheet contains the data. The "Settings" sheet is where the desired location is defined with a latitude and longitude and some customizations can be set. The Score Sheets above were generated with Level 2 granularity, but you can generate a higher-level view by choosing Level 1. You can choose to ignore cooked and canned foods, but be aware this won't work for Level 1 granularity because cooked and canned are sometimes combined into a single food label.

The GenerateAnalysisSheet macro will generate two new sheets with the results for the current settings, one for all foods, and one for foods marked as "Favourites" in the last column of the "Main" sheet. These are not the printable sheets, but can be pasted into a word processing program for pretty formatting. If you want to auto-generate it as a pretty-printable sheet, you have to add your location to the "Weights" sheet, sort the list alphabetically by the Data Label column, and then add the row index of the location you want to the array rowArr in the GenerateAllSheets macro. Running GenerateAllSheets should create the printable Score Sheet.

If you need a custom location and you can’t work with Excel, or the sheets and macros look like spaghetti, send us a note. We're happy to help.