Tyramine Restricted Diet
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By Danita Acquafredda and George Hunter



This Diet Summary is comprised of various references in an attempt to provide knowledge regarding food restrictions and possible adverse reactions. It may be beneficial to know that the references have not agreed on all restricted tyramine foods; thus, it is not the purpose of this writer to contradict or formulate any opinions or conclusions; but rather to provide the information as written by the various references including the various contradictions. All persons who are receiving an MAO inhibitor, such as Procarbazine, should be given a diet by their physician, or dietitian, of which to follow.

Procarbazine is an monoamine oxidase inhibitor (MAOI). Well known drug and food interactions involve drugs that inhibit monoamine oxidase, such as Procarbazine. Monoamine oxidase is in the gastrointestinal tract and inactivates tyramine, an amino acid, which is found various foods. Procarbazine, a MAO inhibitor, interfers with the inactivation of tyramine found in various foods. When drugs, such as Procarbazine (MAOI) prevent the inactivation of tyramine, adverse and serious events may occur when one consumes foods that contain tyramine, such as follows:

  • Elevation of blood pressure, headaches, chest pains
  • diaphoresis (perspiration associated with fever), palpitations.
  • In severe cases, the crisis can result in intracranial hemorrhage, cardiac arrhythmias and cardiac failure.

The tyramine content in foods differ greatly due to different processing, aging, fermentation, ripening and/or contamination. Many foods that contain small amounts of tyramine have developed large amounts of tyramine, if the food products were left to spoil, age (not fresh), or fermented. During a telephone interview with a Dietitian whom prepares diets for patients receiving MAO inhibitors, she strongly emphasized the importance of "fresh foods", that fruits that are permissible should still be very fresh, to avoid left overs kept in the refrigerator especially meats, to check all frozen, dry packaged mixes and can products (prepared foods) for yeast extracts, protein extracts, which many contain and to avoid those entirely; however the yeast found in breads is acceptable. Furthermore, regarding the controversy of "bananas", she also agreed that the reported adverse event involving a banana included the stewing of the banana and banana peel; however, overripe bananas increase in tyramine content, thus, overripe bananas should be avoided.

FOODS THAT MUST BE COMPLETELY AVOIDED:

Cheeses: All aged and mature cheeses, since it is impossible to know the tyramine content all cheeses should be avoided. Including but not limited to cheddar, swiss, blue cheese, mozzarella, parmesan, romano, cheese spreads, cheese casseroles or any foods made with cheese. Only Exceptions: Ricotta, cottage cheese, cream cheese and processed cheese slices.(per the ADA)
Note: The American Dietetic Association is the only reference below that has included "processed cheese slices" as permissible.

Yeast, Brewers and Extracts Includes brewers yeast, extracts such as marmite, yeast vitamin supplements, sourdough and fresh homemade yeast leavened breads; yeast found in prepared foods, soups, can foods, frozen foods, should be checked for the addition of yeast abstracts and should be avoided.
Note: Breads that ARE NOT sourdough, fresh homemade yeast leavened breads are permissible.

Meats/Fish All smoked, aged, picked, fermented, or marinated meats must be avoided. Including but not limited to picked fish, Shrimp paste, picked herring, meat extracts, livers, Non-fresh meats, (such as leftovers), Wild game, Dry sausages or prepared, such as salamoni, bologna, pepperoni, frankfurters, bacon, bologna, liverwurst and ham.
Note: Any smoked, picked, fermented, aged meat or spoiled food may contain high levels of tyramine and must be avoided. Caution should be used in restaurants. Any protein food that is improperly stored or mishandled can contain high levels of tyramine, chicken and beef liver, liver pate and game usually contain high levels due to mishandling. Freshness of food is a key issue while taking an MAOI in order to prevent a potential hypertensive crisis. Thus, eat perishable foods within two days after purchase. Protein Extracts Includes liquid and powdered protein dietary supplements

Fruits and Vegetables. Banana Peels (also overripe bananas must be avoided as the tyramine becomes high as the banana ages) Sauerkraut (since the tyramine contents in sauerkraut differ widely all should be avoided)
Note: All overripe and spoiled fruits should be avoided. Limited Exceptions: Limit intake of 1/2 cup (4oz) of only one per day, providing same is fresh of the following: avocados, bananas, canned figs, raisins, rasberries, red plums.

Beans Includes Broad fava beans, Italian beans, chinese pea pods, beans pastes, fermented bean curds, fermented soya beans, soya sauce, soya bean pastes, Tofu, Miso soup.

Condiments/Seasonings In that protein and yeast extracts are found in various condiments and seasonings and should be avoided, those to be avoided includes but are not limited to bouillion cubes/powder, meat tenderizers, dry packaged and canned soups, gravy, sauces, stew mixes, instant soup dry powder bases, Soy Sauce and Teriyaki.

Soy Sauce (has been reported to contain high levels of tyramine and reactions have been reported with Teriyaki)

Soups Prepared, can, frozen, dry packaged, restaurant soups should be avoided as Protein Extracts, bouillions may be present; furthermore, Miso Soup is prepared from fermented beans and contain high leveles of tyramine, additionally bouillons should also be avoided.

Beverages/Alcholic and Non Includes Beer, Ales, domestic and imported, Wines, especially Chianti vermouth, Whiskey and liqueurs, such as Drambuie and Chartreuse. Nonalcoholic varieties of beers and wines should also be avoided.

Ginseng Some preparations have resulted in adverse reactions and should be avoided

FOODS TO USE WITH CAUTION:

Note: The foods to use with caution, listed below, have been reported to cause adverse events. Adverse reactions may occur if foods are over ripe, contaminated, not handled propertly, near expiration date, or eaten in large qualities, such as more than 1/2 cup. Furthermore, the ADA has advised that only one (1) of these foods may be eaten per day.

Avocados Overripe should be completely avoided; however, if not overripe, small amounts, 1/2 cup, may be safe.

Raspberries Contain tyramine; however small amounts, 1/2 cup, may be safe Nuts Large amounts of Peanuts, coconuts and brazil nuts have been implicated in a hypertensive reaction.

Chocolate May be safe unless consumed in large amounts. Spinach Large amounts of New Zealand or hot weather variety, have resulted in a reaction.

Caffeine Such as coffee, tea, cokes; large amounts may cause a reaction. The ADA suggests restricting these beverages to two 8oz servings per day.

Dairy Products Limit servings of Buttermilk, yogurt and sour cream to 1/2 cup. Dairy products from unpasteurized milk should be avoided.
Note: Cream cheese, cottage cheese or milk should pose little risk, providing, these products have been properly stored and handled and the products should be avoided if close to the expiration date.

FOODS WITH INSUFFICIENT EVIDENCE FOR RESTRICTION:

  • Fresh Fish
  • Mushrooms
  • Cucumbers
  • Sweet Corn
  • Fresh Pineapple
  • Worcestershire Sauce
  • Tomato Juice
  • Curry Powder
  • Beetroot
  • Boiled Egg
  • Cookies (English Biscuit)
  • Cottage Cheese
  • Cream Cheese

References

Physicians' Desk Reference, 48th ed.(1994):1941-2

Matulane Tong, Theodore G., "Foods to Avoid on MAO Inhibitors", Revised by DRUGDEX Editorial Staff 1/94(DC2763)http://www.lycaeum.org/drugs/plants/maoi/maoi.foods.html (20 Jan 99)

Mahan, L. Kathleen, Krause's food, nutrition, and diet therapy 9th ed.(1996)392-3 "Monoamine Oxidase Inhibitors"

Supplement to the Manual of Clinical Dietetics, The American Dietetic Association, (1996) "Tyramine-Controlled Diet"




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