MAOI diet

Discussion in 'Pharmacology' started by Micklemouse, Nov 24, 2004.

  1. Micklemouse

    Micklemouse Platinum Member & Advisor

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    Feb 18, 2004
    from U.K.
    Mono Amine Oxidase is a protein made by the brain to mop up excess neurotransmitters(i.e. serotonin, adrenaline and dopamine). Mono Amine Oxidase Inhibitors(MAOI's) block the action of this protein, potentially leading to neurotoxic and sometimes fatal levels or these neurotransmitters. MAOI antidepressants are rarely prescribed these days, as they require extreme caution when mixed with other drugs, and require a strict diet to be used safely Many naturally ocurring psychoactives(e.g. yohimbe, syrian rue, ayahuascas, tryptamines and harmine/harmalines in general it seems) also have a MAOI action, so be very, very careful...

    MAOI antidepressants include Phenelzine(Nardil), Isocarboxazid, Tranylcypromine(Parnate), Moclobemide(Manerix)

    From Erowid:

    Tyramine is an amino acid which is found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. Monoamine oxidase is found in the gastrointestinal tract and inactivates tyramine; when drugs prevent the catabolism of exogenous tyramine, this amino acid is absorbed and displaces norepinephrine from sympathetic nerve ending and epinephrine from the adrenal glands. If a sufficient amount of pressor amines are released, a patient may experience a severe occipital or temporal headache, diaphoresis, mydriasis, nuchal rigidity, palpitations, and the elevation of both diastolic and systolic blood pressure may ensue (Anon, 1989; Da Prada et al, 1988; Brown & Bryant, 1988).
    On rare occasions, cardiac arrhythmias, cardiac failure, and intracerebral hemorrhage have developed in patients receiving MAOI therapy that did not observe dietary restrictions (Brown & Bryant, 1988). Therefore, dietary restrictions are required for patients receiving MAOIs. Extensive dietary restrictions previously published were collected over a decade ago and due to changes in food processing and more reliable analytical methods, new recommendations have been published (Anon, 1989; McCabe, 1986).

    The tyramine content of foods varies greatly due to the differences in processing, fermentation, ripening, degradation, or incidental contamination. Many foods contain small amounts of tyramine and the formation of large quantities of tyramine have been reported if products were aged, fermented, or left to spoil. Because the sequela from tyramine and MAOIs is dose-related, reactions can be minimized without total abstinence from tyramine-containing foods.Approximately 10 to 25 mg of tyramine is required for a severe reaction compared to 6 to 10 mg for a mild reaction. Foods that normally contain low amounts of tyramine may become a risk if unusually large quantities are consumed or if spoilage has occurred (McCabe, 1986).
    Three lists were compiled (foods to avoid, foods that may used in small quantities, and foods with insufficient evidence to restrict) to minimized the strict dietary restrictions that were previously used and improve compliance and safety of MAOI therapy. The foods to avoid list consists of foods with sufficient tyramine (in small or usual serving sizes) that would create a dangerous elevation in blood pressure and therefore should be avoided (McCabe, 1986)

    Alcoholic beverages
    Avoid Chianti wine and vermouth.
    Consumption of red, white, and port wine in quantities less than 120 mL present little risk (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).
    Beer and ale should also be avoided (McCabe, 1986), however other investigators feel major domestic (US) brands of beer is safe in small quantities (½ cup or less than 120 mL) (Anon, 1989; Da Prada, 1988), but imported beer should not be consumed unless a specific brand is known to be safe.
    Whiskey and liqueurs such as Drambuie and Chartreuse have caused reactions.
    Nonalcoholic beverages (alcohol-free beer and wines) may contain tyramine and should be avoided (Anon, 1989; Stockley, 1993).

    Banana peels
    A single case report implicates a banana as the causative agent, which involved the consumption of whole stewed green banana, including the peel. Ripe banana pulp contains 7 µg/gram of tyramine compared to a peel which contains 65 µg/gram and 700 µg of tyramine and dopamine, respectively (McCabe, 1986).

    Bean curd
    Fermented bean curd, fermented soya bean, soya bean pastes contain a significant amount of tyramine (Anon, 1989).

    Broad (fava) bean pods
    These beans contain dopa, not tyramine, which is metabolized to dopamine and may cause a pressor reaction and therefore should not be eaten particularly if overripe (McCabe, 1986; Anon, 1989; Brown & Bryant, 1988).

    Tyramine content cannot be predicted based on appearance, flavor, or variety and therefore should be avoided.
    Cream cheese and cottage cheese have no detectable level of tyramine (McCabe, 1986; Anon, 1989, Brown & Bryant, 1988).

    Fresh fish (Anon, 1989; McCabe, 1986) and vacuum-packed pickled fish or caviar contain only small amounts of tyramine and are safe if consumed promptly or refrigerated for short periods; longer storage may be dangerous (Anon, 1989).
    Smoked, fermented, pickled (Herring) and otherwise aged fish, meat, or any spoiled food may contain high levels of tyramine and should be avoided (Anon, 1989; Brown & Bryant, 1988).

    Some preparations have resulted in a headache, tremulousness, and manic-like symptoms (Anon, 1989).

    Protein extracts
    Three brands of meat extract contained 95, 206, and 304 µg/gram of tyramine and therefore meat extracts should be avoided (McCabe, 1986).
    Avoid liquid and powdered protein dietary supplements (Anon, 1989).

    nonfresh or liver
    no detectable levels identified in fresh chicken livers
    high tyramine content found in spoiled or unfresh livers (McCabe, 1986).
    Fresh meat is safe, caution suggested in restaurants (Anon, 1989; Da Prada et al, 1988).
    Sausage, bologna, pepperoni and salami contain large amounts of tyramine (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).
    No detectable tyramine levels were identified in country cured ham (McCabe, 1986).

    Tyramine content has varied from 20 to 95 µg/gram and should be avoided (McCabe, 1986).

    Shrimp paste
    Contain a large amount of tyramine (Anon, 1989).

    Should be avoided as protein extracts may be present; miso soup is prepared from fermented bean curd and contain tyramine in large amounts and should not be consumed (Anon, 1989).

    Brewer's or extracts - yeast extracts (Marmite) which are spread on bread or mixed with water,
    Brewer's yeast, or Yeast vitamin supplements should not be consumed.
    Yeast used in baking is safe (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).
    The foods to use with caution list categorizes foods that have been reported to cause a hypertensive crisis if foods were consumed in large quantities, stored for prolong periods, or if contamination occurred. Small servings (½ cup, or less than 120 mL) of the following foods are not expected to pose a risk for patients on MAOI therapy (McCabe, 1986).


    (½ cup or less than 120 mL)
    Alcoholic beverages - see under foods to avoid.
    Avocados - contain tyramine, particularly overripe (Anon, 1989) but may be used in small amounts if not overripened (McCabe, 1986).

    Caffeine - contains a weak pressor agent, large amounts may cause a reaction (Anon, 1989).

    Chocolate - is safe to ingest for most patients, unless consumed in large amounts (Anon, 1989; McCabe, 1986).

    Dairy products - Cream, sour cream, cottage cheese, cream cheese, yogurt, or milk should pose little risk unless prolonged storage or lack of sanitation standards exists (Anon, 1989; McCabe, 1986). Products should not be used if close to the expiration date (McCabe, 1986).

    Nuts - large quantities of peanuts were implicated in a hypertensive reaction and headache. Coconuts and brazil nuts have also been implicated, however no analysis of the tyramine content was performed (McCabe, 1986).

    Raspberries - contain tyramine and small amounts are expected to be safe (McCabe, 1986).

    Soy sauce - has been reported to contain large amounts of tyramine and reactions have been reported with teriyaki (Anon, 1989), however analysis of soy sauce reveals a tyramine level of 1.76 µg/mL and fermented meat may have contributed to the previously reported reactions (McCabe, 1986).

    Spinach, New Zealand prickly or hot weather - large amounts have resulted in a reaction (Anon, 1989; McCabe, 1986).

    Drug Interaction Guide For MAOI Antidepressants
    The following is a list of interactions between Monoamine Oxidase Inhibitor (MAOI) antidepressants and other common medications/drugs.

    MAOI Interactions With:
    Other Antidepressants

    Asthma Medicines

    Cold, Cough, Allergy, Sinus, Decongestant and Hay Fever Medications

    Diabetes Medications

    Medications to Treat Low Blood Pressure

    Medications for High Blood Pressure
    MAOI Interactions With:

    Mood Stabilizers

    Painkillers and Anesthetics

    Sedatives and Tranquilizers

    Stimulants (Pep Pills) and Street Drugs

    Weight Loss and Appetite-Suppression Medications

    Other Medications

    Interaction of MAOI antidepressants with other antidepressants

    Interaction of MAOI antidepressants with Tricyclic antidepressants, especially desipramine (Norpramin, Pertofrane) and clomipramine (Anafranil) Some (e.g., clomipramine) may cause a hyperpyrexic crisis or seizures.
    Others (e.g. desipramine) may cause a hypertensive crisis
    Tetracyclic antidepressants, especially Bupropion (Welibutrin) Hypertensive crisis (noradrenergic syndrome)
    SSRIs (all are extremely dangerous)Hyperpyrexic crisis (serotonin syndrome)
    Other MAOIs Hyperpyrexic crisis (serotonin syndrome)
    Hypertensive crisis (noradrenergic syndrome)
    Serotonin antagonists, including trazodone (Desyrel) and nefazodone (Serzone) Hyperpyrexic crisis (serotonin syndrome)
    Mirtazapine (Remeron)Hypertensive crisis (noradrenergic syndrome)
    Venlafaxine (Effexor) Hypertensive crisis (noradrenergic syndrome)

    Interaction of MAOI antidepressants with Asthma Medicines

    Interaction of MAOI antidepressants with Ephedrine, a bronchodilator contained in Marax, Quadrinal, and other asthma drugs Hypertensive crisis
    Inhalants which contain albuterol (Proventil, Ventolin), metaproterenol (Alupent, Metaprel), or other beta- adrenergic bronchodilators Blood pressure elevations and a rapid heart.
    Beclomethasone and other nonsystemic steroid inhalers are generally safer
    Theophylline (Theo-Dur), a common ingredient in asthma drugs Rapid heart and anxiety

    Interaction of MAOI antidepressants with Cold, Cough, Allergy, Sinus, Decongestant and Hay Fever Medications

    Interaction of MAOI antidepressants with Antihistamines: terfenadine (Seldane-D)
    Can cause an increase in MAOI blood levels
    Dextromethorphan - found in many cold and cough medications, especially any drug with DM or Tuss in its name. These include Bromarest-DM or -DX, Dimetane-DX cough syrup, Dristan Cold & Flu, Phenergan with Dextromethorphan, Robitussin-DM, several Tylenol cold, cough, and flu preparations, and many others Hyperpyrexic crisis (serotonin syndrome).
    May also cause brief episodes of psychosis or bizarre behavior
    Ephedrine - found in Bronkaid, Primatene, Vicks Vatronol nose drops, and several other asthma and cold medications. Hypertensive crisis (noradrenergic syndrome)
    Oxymetazoline (Afrin) nose drops or sprays used to treat nasal decongestion. Hypertensive crisis (noradrenergic syndrome)
    Phenylephrine can be found in Dimetane, Dristan decongestant, Neo-Synephrine nasal spray and nose drops, and many other similar preparations, including some eye-drop medications Hypertensive crisis (noradrenergic syndrome)
    Phenylpropanolamine - found in Alka-Seltzer Plus Cold and Night-Time Cold medicine, Allerest, Contac decongestants, Coricidin D decongestants, Dexatrim appetite pills, Dimetane-DC Cough syrup, Ornade Spansules, Robitussin-CF Sinarest, St. Joseph Cold Tablets, Tylenol Cold medicine, and many others Hypertensive crisis (noradrenergic syndrome)
    Pseudoephedrine - found in Actifed, Allerest No Drowsiness formula, Benadryl combinations, CoAdvil, Dimetane DX cough syrup, Dristan Maximum Strength, Robitussin DAC syrup, Robitussin-PE, Seldane D tablets, Sinarest No Drowsiness, Sinutab, Sudafed, Triaminic Nite Light, Tylenol allergy, sinus, flu, and cold preparations, several Vicks products including NyQuil, etc. Hypertensive crisis (noradrenergic syndrome)

    Interaction of MAOI antidepressants with Diabetes Medications

    Interaction of MAOI antidepressants with Insulin May cause a greater drop in blood sugar
    Oral hypoglycemic agents May cause a greater drop in blood sugar

    Interaction of MAOI antidepressants with Medications to Treat Low Blood Pressure

    Interaction of MAOI antidepressants with Sympathomimetic amines including:
    dopamine (intropin)
    epinephrine (Adrenalin)
    isoproterenol (isuprel)
    metaraminol (Aramine)
    methyidopa (Aidomet)
    norepinephrine (Levophed) Hypertensive crisis (noradrenergic syndrome) (These drugs cause blood vessels to constrict.)

    Interaction of MAOI antidepressants with Medications to Treat Medications for High Blood Pressure

    Interaction of MAOI antidepressants with
    Guanadrel (Hylorel)
    Guanethidine (ismelin)
    Hydralazine (Apresoline)
    methyldopa (Aldomet)
    reserpine (Serpasil) These blood-pressure medications may cause an increase in blood pressure when combined with MAOIs
    Beta-blockers May be more potent when combined with MAOIs, leading to a greater than expected drop in blood pressure and dizziness when standing
    Calcium channel blockers Appear to be reasonably safe when combined with MAOIs. Check with your doctor and monitor blood pressure closely. Watch for a greater than expected drop in blood pressure
    Diuretics Watch for a greater than expected drop in blood pressure. May increase blood level of the MAOI

    Interaction of MAOI antidepressants with Mood Stabilizers

    Interaction of MAOI antidepressants with Carbamazepine (Tegretol) Hyperpyrexic crisis (serotonin syndrome).
    MAOI may cause carbarnazepine levels to fall, so epileptics may experience seizures
    Lithium (Eskalith) Found to cause hyperpyrexic crisis (serotonin syndrome) in animal studies

    Interaction of MAOI antidepressants with Painkillers and Anesthetics

    Interaction of MAOI antidepressants with Anesthetics: general Tell your anesthesiologist you are on an MAOI. If possible, discontinue the MAOI two weeks before elective surgery.
    Muscle relaxants such as succinylcholine and tubocurarine may have a more pronounced or prolonged effect. General anesthetics such as halothane may lead to excitement, excessive depression of the brain, or hyperpyrexic reactions.

    Anesthetics: local Some contain epinephrine or other sympathomimetics-make sure you tell your dentist or surgeon you are taking an MAOI
    Cyclobenzaprine (Flexeril) Hyperpyrexic crisis (serotonin syndrome) or severe seizures
    Meperidine (Demerol) A single injection can cause seizures, coma, and death (serotonin syndrome). Most other narcotics, including morphine and codeine, have been used safely with MAOIs

    Interaction of MAOI antidepressants with Sedatives and Tranquilizers

    Interaction of MAOI antidepressants with Alcohol May have enhanced sedative effects, especially when combined with, pheneizine (Nardil.) This could be hazardous when driving or operating dangerous machinery.
    Barbiturates (such as phenobarbital) Enhanced sedative effects. This could be hazardous when driving or operating dangerous machinery.
    Buspirone (BuSpar) Enhanced sedative effects. This could be hazardous when driving or operating dangerous machinery.
    Major tranquilizers (neuroleptics) Enhanced sedative effects. Some neuroleptics may cause a drop in blood pressure when combined with MAOIs. May be hazardous when driving or operating dangerous machinery.
    Minor tranquilizers (benzodiazepines) such as alprazolam (Xanax), diazepam (Valium), and others Enhanced sedative effects. May be hazardous when driving or operating dangerous machinery.
    Sleeping pills Enhanced sedative effects. May be hazardous when driving or operating dangerous machinery.
    L-tryptophan Hyperpyrexic crisis (serotonin syndrome); blood-pressure elevations; disorientation, memory impairment, and other neurologic changes

    Interaction of MAOI antidepressants with Stimulants (Pep Pills) and Street Drugs

    Interaction of MAOI antidepressants with Amphetamines ('speed' or 'crank')
    benzphetamine (Didrex)
    dextroamphetamine (Dexedrine)
    methamphetamine (Desoxyn)
    methylphenidate (Ritalin) Hypertensive crisis (noradrenergic syndrome) is possible.
    Methylphenidate considered somewhat less risky than the amphetamines

    Interaction of MAOI antidepressants with Weight Loss and Appetite-Suppression Medications

    Interaction of MAOI antidepressants with Cylert (Pemoline) Drug interactions have not been studied in humans. Great caution is advised.
    Fenfluramine (Pondimin) Hyperpyrexic crisis (serotonin syndrome)
    Phendimetrazine (Plegiline) Hypertensive crisis (noradrenergic syndrome)
    Phentermine and some over-the- counter medications Hypertensive crisis (noradrenergic syndrome)
    Phenylpropanolamine (Acutrim) Hypertensive crisis (noradrenergic syndrome)

    Interaction of MAOI antidepressants with Other Medications/Drugs

    Interaction of MAOI antidepressants with Caffeine Probably safe in moderate amounts. Avoid large amounts - may cause
    blood-pressure elevations, a racing heart, and anxiety.
    Disulfiram (Antabuse) (used to treat alcoholism) Severe reactions when mixed with an MAOI
    L-dopa (Sinemet) (used to treat Parkinson's disease) Hypertensive crisis (noradrenergic syndrome)

    Source: David D. Burns, M.D.: The Feeling Good Handbook ( Plume )
  2. wednesday

    wednesday Newbie

    Reputation Points:
    Feb 10, 2004
    from U.S.A.
    Monoamine Oxidase Inhibitors (MAOIs) are
    drugs used to treat depression, high blood
    pressure, and other medical conditions. If you
    are taking MAOIs, you will follow a special diet.
    A side effect of this type of medicine is that a
    normally harmless substance in food, tyramine
    (TY-ra-meen), is not broken down by the body.
    High levels of tyramine can cause blood vessels
    to narrow. This can lead to very high blood
    pressure, a severe headache, and possibly
    To avoid these serious side effects, you should
    avoid certain foods or eat them only in small
    amounts. The chart on the inside pages will
    help guide you in your food choices.
    Important tips to remember
    • Foods that are close to spoiling, are aged
    (like cheese), or have been stored for a
    long time have higher levels of tyramine
    than fresh foods do. Try to prepare and eat
    fresh foods. Look for the expiration date
    on food packages. Avoid using dairy products
    that are close to their expiration date.
    • Start the MAOI diet (also called the “lowtyramine”
    or “tyramine-controlled” diet)
    when you begin taking MAOI medication.
    • Continue the MAOI diet for four weeks
    (or as directed by your physician) after
    stopping the MAOI medication.

    Cheese and
    Dairy Products
    - milk
    - decaf coffee and tea
    - carbonated drinks
    - whole-wheat enriched
    white breads, rolls,
    crackers, and quick
    - cooked and dry cereals
    - cottage cheese,
    farmer or pot cheese,
    cream cheese, ricotta
    cheese, and processed
    - cakes and cookies
    - gelatins
    - ice cream and sherbets
    - pastries
    - puddings
    - all
    - all
    - fresh, frozen, or
    canned fruits and juices
    - chocolate drinks
    - coffee, tea, and
    other caffeinated
    - white wine and
    clear spirits (limit
    two 8 oz. servings)
    - none
    - none
    - buttermilk (limit to
    4 oz.), sour cream,
    yogurt (national
    brands only — limit
    to 4 oz. per day)
    - chocolate desserts
    - none
    - none
    - none
    - alcoholic drinks,
    especially beer,
    ale, wine (Chianti,
    burgundy, sherry,
    vermouth, sauterne),
    and nonalcoholic
    beer and wine
    - acidophilus milk
    - cheese breads
    - crackers
    - sourdough and
    fresh, homemade,
    - none
    - all other cheese:
    aged cheese,
    cheddar, Gouda,
    Gruyère, mozzarella,
    Roquefort, and
    - cheese-filled
    desserts and
    - quiche with cheese
    - none
    - banana peel extract
    - overripe and
    spoiled fruits

    - all fresh or frozen
    meats, fish, or poultry
    - white and sweet potatoes
    - grits, pasta, and rice
    - all cream and broth
    soups, except those on
    the Avoid list
    - sugars, hard candies,
    honey, molasses, and
    - all fresh, frozen,
    canned or dried vegetables
    and vegetable
    juices, except those on
    the Avoid list
    - caviar (more
    than 1 oz.)
    - chicken and beef
    - dried, salted, and
    pickled fish
    - fermented and dry
    - salami
    - dried meats and
    meat extracts
    - none
    - soups from Italian
    broad beans and
    fava beans
    - cheese soup
    - soup made with
    beer or wine
    - any soup cubes or
    meat extract
    - packet soups and
    packaged soups
    - miso soup
    - imported chocolate
    - Chinese pea pods
    - fava beans and
    Italian broad beans
    - sauerkraut
    - fermented soybean
    (miso and some
    tofu products)
    - aged meats and
    - fresh sausage and
    - canned sardines
    - canned meats
    - fish roe (caviar) and
    paˆté (limit to 1 oz.)
    - none
    - none
    - chocolate candies
    and chocolate syrups
    - none
    Meats, Fish
    and Poultry
    Potatoes and
  3. Micklemouse

    Micklemouse Platinum Member & Advisor

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    Feb 18, 2004
    from U.K.
    Nice one Wednesday, good info! I posted something
    similar a while back, with info on which dugs are
    MAOI's and interactions with other drugs - any chance
    of getting it moved over, Mods?[​IMG]
  4. govdus

    govdus Newbie

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    Aug 19, 2007
    50 y/o
    maoi diet simple question

    how long before taking maoi do i have to be on a maoi diet? is 1 day enough? i tought of a maoi diet today and fasting tomorow, since taking maoi is planed for tomorow afternoon... would that be allright?
  5. Neosapien

    Neosapien Silver Member

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    Sep 16, 2006
    from U.S.A.
    Re: maoi diet simple question

    A day should be fine as far as foods go, its the pharmaceuticals one needs to especially watch out for.
    My friend doesn't like to take Aya on a totally empty stomach - some bland noodles or rice a few hours beforehand makes for a much more pleasant trip.
  6. fnord

    fnord Palladium Member

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    Dec 8, 2003
    Re: maoi diet simple question

    /swim only eats rice with some spices a day and a half before hand.cuts down on nausea.
  7. Nagognog2

    Nagognog2 Iridium Member

    Reputation Points:
    Feb 1, 2005
    Re: maoi diet simple question

    First off - read the rules.

    Regards a MAOI diet, it depends on what MAOI I am planning on using. If it is a short-acting one such as Harmaline, then a day will be sufficient. Eating a light diet the preceding day - or fasting (better still) will keep SWIM safe for the duration. The day after the experience, SWIM can return to his usual regimen.

    If I am playing with a prescribed, long-acting MAOI - I should consult his physician.
  8. NeuroChi

    NeuroChi is not his mind Platinum Member & Advisor

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    Dec 18, 2007
    from earth
    If one was to consume an MAOI (harmal or syrian rue for example) how long should one wait until these foods can be consumed safely?

    How long in advance should this diet be employed?
  9. psyche

    psyche Palladium Member

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    Feb 28, 2006
    30 y/o from finland
    ^^ While not sure I think it is something like 12 hours. Isn't it included in the erowid's foods to avoid?

    Any you's have any personal experience with getting fucked up by eating the wrong foods? SWIM personally doesn't beleive the restrictions to be as serious as they are; that is he thinks everyone, or maybe even not that many people get sick by eating the wrong foods. I remember SWIM breaking some of them with no bad reaction. On the other hand once, about 3hrs after consuming the peganum harmala he ate some oat cerials with milk and got terrible nausea, pounding heart and dizzyness. Also I remember reading Rätsch or Jonathan Ott critisize this tyramine-theory of adverse effects but don't remember exactly what were their grounds.
  10. Paracelsus

    Paracelsus Platinum Member & Advisor

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    Aug 31, 2006
    from U.S.A.
    As far as I know, the harmala alkaloids are reversible and selective for MAO-A (RIMAs). RIMAs are considered to be less likely to cause the "cheese effect," probably because they are competitive inhibitors and thus, there is a limit up to where tyramine levels can rise (as opposed to irreversible "suicide" MAOIs).

    It would still be a good idea to avoid the really notorious foods (aged cheeses, Chianti, etc) and limit the consumption of other tyramine-containing foods.
  11. psyche

    psyche Palladium Member

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    Feb 28, 2006
    30 y/o from finland
    An in depth look at tyramine content of some foods

    I found this on another forum and it isn't available online on the site of Journal of Clinical Psychopharmacology, so I've got no link to offer. It's pretty well researched article with some new info for SWIM at least.

    Walker, Scott E. MScPhm. Shulman, Kenneth I. MD, SM, FRCP(C). Tailor, Sandra A.N. PharmD. Gardner, David BScPhm.

    Tyramine Content of Previously Restricted Foods in Monoamine Oxidase Inhibitor Diets.
    Journal of Clinical Psychopharmacology. 16(5):383-388, October 1996"

    "It has been clearly demonstrated that individuals who are taking MAOIs are more sensitive to the pressor effects of tyramine. [15] A critical issue in dietary restriction relates to the amount of tyramine that will produce an increase in blood pressure. Both Blackwell and Mabbitt [16] as well as Horowitz and associates [17] have observed increases in blood pressure with the ingestion of only 6 mg of tyramine. However, Blackwell and Mabbitt [16] were unable to reproduce these results on rechallenge with 6 mg in the same subject. Bieck and Antonin [15] demonstrated that an 8-mg oral dose of tyramine is sufficient to increase systolic pressure by 30 mm Hg in 50% of subjects receiving tranylcypromine. However, they also demonstrated a wide intra-individual variation in responses in some patients that may be due to variability in both the rate and extent of absorption. Furthermore, many foods have been reported to contain variable amounts of other pressor agents [18-21] that may also increase blood pressure, possibly contributing to variable response. [15,16] Therefore, we have used a conservative upper limit of 6 mg of tyramine as a guideline for safe ingestion. This is identical to the limit that we have used previously. [7,8,11]

    In this study, we again analyzed an Italian Chianti wine and found no tyramine. This is in agreement with the low or negligible levels reported by others. [8,13] Chianti wine has been widely restricted for many years based on a single report of a tyramine concentration of 25.4 mg/liter. [17] However, case reports of hypertensive crises associated with this or other wines are lacking.

    It is of interest to note that in our assay, if we eliminate sodium lauryl sulfate (which acts as a counter ion) from our mobile phase, a compound in Chianti wine coelutes with tyramine. Liquid chromatographic columns can separate this coeluting peak with varying degrees of success. Therefore, it seems possible that the long-standing restriction of Chianti wine may have been due to analytical interference that led to an overestimation of the tyramine content. This points out the need to carefully validate the analytical method before reporting tyramine concentrations.

    By far, most reported fatal and nonfatal MAOI-related hypertensive reactions have been associated with the ingestion of cheese. [8] The restriction of all aged cheeses is universally accepted. However, not all cheeses should be banned. In this study, we analyzed mozzarella cheese and found extremely low amounts (0.01 mg/g), even when stored at room temperature for 5 days. The content of this part-skim mozzarella cheese is much lower than the 0.16 mg/g observed in our previous report of mozzarella cheese (28% milk fat). [8] Nevertheless, both concentrations would be regarded as safe when less than 30 g of cheese is ingested. Furthermore, the tyramine content provided in the current report is similar to the low concentrations reported for other mild and fresh varieties of cheeses such as cottage cheese, cream cheese, ricotta, and processed cheeses. [8,19,13,16] In this study, we also analyzed the tyramine content of the packaged cheese powder found in a Kraft Macaroni & Cheese Dinner (Kraft Foods, Inc., Glenview, IL) and found no tyramine.

    In this study, we analyzed only one beer, a bottled German beer (Beck's, Brauerei Beck & Co., Bremen, Germany) and found it to contain small amounts of tyramine (1.0 mg/liter). This is in agreement with the results of the analysis of other bottled beers analyzed by our group [8,11] and others. [17,22,23] However, we have previously reported alarmingly high tyramine concentrations of tyramine (27.05-112.91 mg/liter) in four tap beers [11] and suggest that storage and contamination of the hose from the keg to the tap may provide conditions conducive to the production of tyramine. We recommend that tap beers be avoided by patients who are taking MAOIs, and because no bottled or canned beers from North American breweries have been identified as containing dangerous amounts of tyramine, we acknowledge that these can be consumed in moderation.

    A number of investigators have reported that banana pulp is safe, [8,24] although the peel has been observed to contain moderate to high amounts of several vasoactive substances, including serotonin, dopamine, and noradrenaline in addition to tyramine. [25] In this study, we observed the skin of a blackened banana to contain 2.58 mg of tyramine, whereas the pulp of each of two blackened bananas contained less than half this amount. Both of these bananas had been stored at room temperature for more than 1 week beyond the time when they were a ripened yellow. In our previous study, the tyramine content of a fresh banana was below the limit of detection and one whole peel was observed to have 1.42 mg of tyramine. [8] Although the tyramine content does appear to have increased with storage, this could easily be due to the variability in content between bananas. Furthermore, the bananas tested in this study, even after prolonged storage, did not contain dangerous amounts of tyramine. Therefore, we conclude that the pulp of an overripe banana is safe.

    Coffin [24] reported that raspberries contain 0.048 mg/g of tyramine (range: 0.013-0.093 mg/g). Our own analysis of raspberries with different presentations (e.g., stored at room temperature or refrigerated for 4 days, with or without mold, in jam, and frozen) yielded tyramine concentrations ranging from 0 to 0.001 mg/g for berries and 0.021 mg/g for a frozen berry product. Based on our results and those of Coffin as well as the observation that there are no reports linking raspberries to hypertensive episodes, we conclude that raspberries are safe.

    Prepared and sliced meat products
    Fresh, sliced cold meat and other meat products were analyzed in this study and generally found to contain low amounts of tyramine per 30-g serving. This is in agreement with our previous report. [8] We also chose to analyze some canned meat and pasta products (Chef Boyardee, American Home Products, Inc., Madison, NJ) and found them to contain safe amounts of tyramine per serving.

    The freshness of meat, specifically chicken livers, has been identified as a factor affecting the amount of tyramine. [26] In this study, we observed fresh chicken liver to contain very small amounts of tyramine. However, after 9 days' storage at room temperature, the tyramine content had soared to 2.13 mg/g. Although the chicken liver stored for 9 days at room temperature could not have been mistaken as fresh, and would not likely have been prepared and eaten by anyone, it does illustrate a point about freshness. A previous evaluation of chicken liver indicated that storage in the refrigerator for 5 days increased the tyramine concentration from 0 to 0.051 mg/g. [8] The current method adjusted the storage conditions only to create a definitive test of freshness on tyramine in chicken liver.

    As for cheeses, the degree of aging and variety of cured meats (e.g., salami, mortadella, pastrami) are tremendous and tyramine content can range from low and safe amounts to dangerously high levels. [8,9,21] Of most concern are the air-dried sausages, for example, salami. As sausages dry, an increase in the liberation of free amino acids has been observed to occur. [27] Because sausage can contain microorganisms with decarboxylase activity, [28] tyrosine can be converted to tyramine during the drying process. In this study, we tested a variety of air-dried sausages, analyzing samples taken both from the core and outer rim (next to the skin). In three of the four samples, the sample nearest the skin contained 20 to 360% more tyramine, whereas in the fourth sample the concentration in the center of the sausage was sevenfold higher than the sample taken from the area next to the skin. Of the 10 sausages tested, 2 were observed to contain more than 6 mg of tyramine per 30-g serving, and 2 others were observed to contain between 4 and 6 mg. Therefore, although there are no case reports associating air-dried sausages with hypertensive episodes, we recommend that air-dried sausages continue to be a dietary restriction for patients receiving MAOIs because of the variability in tyramine content among sausages and because of the likelihood that a serving will be greater than 30 g. However, as was pointed out previously, this restriction does not include fresh sliced-meat products, such as sliced cooked ham.

    In this study, sauerkraut was observed to have a significant tyramine content per serving, (0.031 mg/g). This amount is lower than previously reported by Shulman and colleagues [8] (0.055 mg/g) but still within the range (0.020-0.095 mg/g) reported by Lovenberg [25] and Da Prada and associates. [9] All of these reports suggest a potentially dangerous tyramine content per serving, yet there are no case reports linking sauerkraut to hypertensive episodes. It is possible that the tyramine in sauerkraut may not be completely bioavailable or that the rate of absorption of tyramine from sauerkraut is slow, producing little change in blood pressure. However, in view of the confirmed high tyramine concentration per serving of sauerkraut, we recommend that it be restricted in patients on a regimen of MAOIs.

    Improperly stored or spoiled food can create an environment where tyramine concentrations may increase. These foods must have either free tyrosine or tyrosine liberated on storage, which is then converted to tyramine by microorganisms with decarboxylase enzymes. [27] This was shown to occur with the chicken livers stored at room temperature for 9 days and is the postulated mechanism for production of tyramine in air-dried sausages and tap beers. [11] However, for a number of other foods (raspberries, mozzarella cheese, and bananas), improper or prolonged storage did not increase the tyramine content to unsafe levels. In these later cases, although conditions of growth were present, it is likely that either tyrosine was not liberated, was liberated in only small quantities, or decarboxylation activity was lacking.

    Our analysis of a single chocolate bar (Toblerone, Kraft General Foods Canada Inc., Don Mills, Ontario, Canada; 35-g bar) failed to demonstrate measurable quantities of either tyramine or phenylethylamine, yet we did observe significant quantities of theobromine (2.78 mg/g) and caffeine (1.07 mg/g). The choice of a Toblerone chocolate bar arose from a case in which a young woman maintained on tranylcypromine (Parnate, SmithKline Beecham Pharmaceuticals, Oakville, Ontario, Canada) reported symptoms of dizziness, light-headedness, blurred vision, and headache 45 min after ingesting an unspecified amount of a Toblerone chocolate bar. The patient arrived at a hospital emergency department and was found to have normal blood pressure and heart rate, although she demonstrated slurred speech and pallor. We believe that many case reports, with only subjective findings that are not validated by objective measures, have led to the restriction of many foods. Headaches, which can occur for a variety of reasons, can also occur with chocolate ingestion in patients who are not taking MAOIs. In these cases, the cause does not appear to be related to either tyramine or phenylethylamine. We would suggest that this reaction may have been due to the stimulant effects of the methylxanthines (theobromine and caffeine).

    Soy sauce and other soy bean preparations have been found to contain tyramine in significant concentrations, [9,10,29] whereas others have reported low concentrations. [8,13] From an analysis of Far Eastern cuisine, Da Prada and Zurcher [10] reported tyramine concentrations of 293 mg/liter and 878 mg/liter in two samples of soy sauce. Similarly, high concentrations (941 mg/liter) of tyramine were observed in the single soy product tested in this study. As with some other foods, the variation in tyramine content reported in various studies and between different soy sauce products creates a potential hazard. We recommend that soy sauce be avoided by patients taking MAOIs but acknowledge that patients may be able to ingest some brands without serious consequences...."
    Last edited: Apr 2, 2008