The guiding principle for a MAOI compliant diet is to avoid foods with Tyramine.
Besides occurring in some foods, Tyramine is also generated in foods during the spoiling or decay process.
Foods to avoid:
Meat Products
beef liver
chicken liver
fermented sausages (pepperoni, salami)
luncheon meats
Fish Products
caviar
cured fish
dried or pickled herring
shrimp paste
Milk Products
aged cheeses
processed cheeses
sour cream
yogurt
Fruits and Vegetables
bananas
overripe fruits
overripe avocados
fava beans
sauerkraut
canned figs
Italian green beans
snow peas
Alcohol
red wines, Chianti wine
beers containing yeast
sherry
vermouth
Yeast/Soy sauce/Miso
concentrated yeast products
brewer's yeast
Miso (a type of soup or sauce)
Soy sauce
This excerpt from Micromedex Inc. does a great job of explaining the reason behind Nardil food restrictions.
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).
Source:
Kaplan MD, Harold I. and Sadock MD, Benjamin J. Synopsis of Psychiatry, Eighth Edition 1998 Baltimore: Williams & Wilkins.
(c)1974-1994 Micromedex Inc. - All rights reserved - Vol. 82 Exp. 12/94
Besides occurring in some foods, Tyramine is also generated in foods during the spoiling or decay process.
- Check packaged foods for freshness. Don't consume products beyond the freshness date.
- Cook all foods to the proper temperature.
- Maintain cold foods at the proper temperature.
- Don't refreeze foods that have been thawed.
- Avoid leftovers, even if they have been refrigerated.
- Consume cooked foods promptly, making sure proper food temperature is maintained.
Foods to avoid:
Meat Products
beef liver
chicken liver
fermented sausages (pepperoni, salami)
luncheon meats
Fish Products
caviar
cured fish
dried or pickled herring
shrimp paste
Milk Products
aged cheeses
processed cheeses
sour cream
yogurt
Fruits and Vegetables
bananas
overripe fruits
overripe avocados
fava beans
sauerkraut
canned figs
Italian green beans
snow peas
Alcohol
red wines, Chianti wine
beers containing yeast
sherry
vermouth
Yeast/Soy sauce/Miso
concentrated yeast products
brewer's yeast
Miso (a type of soup or sauce)
Soy sauce
This excerpt from Micromedex Inc. does a great job of explaining the reason behind Nardil food restrictions.
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).
Source:
Kaplan MD, Harold I. and Sadock MD, Benjamin J. Synopsis of Psychiatry, Eighth Edition 1998 Baltimore: Williams & Wilkins.
(c)1974-1994 Micromedex Inc. - All rights reserved - Vol. 82 Exp. 12/94