Monoamine oxidase inhibitors (MAOIs) are a class of medications used to treat depression. It works by suppressing the action of monoamine oxidase (MAO), an enzyme found in the body that breaks down the monoamines (tyramine) found in foods. In the presence of certain MAOIs, there is an increased level of tyramine that can cause a significant increase in blood pressure, headache, nausea and vomiting. The severity of the attack is related to both the drug regimen (type and dose) and the amount of tyramine ingested. Therefore, it is important for people taking MAOIs to eliminate foods containing large amounts of tyramine.
Bread, Cereal, Grains and Pasta
Avoid homemade and fresh yeast breads, sourdough breads and breads made with aged cheeses, aged meats or yeast extracts. Avoid foods with brewer's yeast as an ingredient (which can be present in convenience foods).
Fruits and Vegetables
Avoid overripe and dried fruits like raisins. For vegetables, avoid snow pea pods, broad (fava) bean pods and sauerkraut. Avocados and bananas should be limited to no more than one serving per day.
Milk and Dairy
Avoid aged cheese spreads and all aged cheeses (blue, cheddar, Swiss, Stilton). Avoid imitation cheeses except cottage and ricotta. Tyramine content increases as the cheese ages. Any outdated or nonpasteurized dairy products should also be avoided.
Meat and Meat Substitutes
Avoid any aged, dried, fermented or pickled meats and sausage. All processed meats should be avoided including bacon, sausage, breakfast sausage, pepperoni, salami, bologna, ham, hot dogs and corned beef. Salted and smoked meats and fish are also high in tyramine. Avoid any meats prepared with tenderizer. Soybean products like tofu, miso, soy sauce, bean curd and tempeh are to be avoided as well.
Fats and Condiments
Avoid any dressings made with aged cheese, and sauces or gravies containing meat extracts. Yeast or meat extracts may also be found in soup mixes (canned or dry packed) and bouillon cubes.
Desserts
Desserts containing chocolate should be limited to no more than one serving per day.
Beverages
Avoid tap or nonpasteurized beer, ale, red and white wine, nonalcoholic beer and mixed drinks. Caffeine-containing products (coffee, tea and soft drinks) should be limited to three 8-ounce servings a day.
Additional Tips
Tyramine is an amino acid naturally present in certain foods, and it can also result from the bacterial breakdown of protein in foods as they age. Therefore it is best to eat only fresh foods, no leftovers or foods past their expiration dates. Eat perishable refrigerated items within 48 hours of purchase. Freeze leftovers within 24 hours. Cooking does not destroy tyramine content. Weight control powders, diet supplements and pills may contain tyramine. When in doubt, consult with your doctor or a registered dietitian.
References
- McCabe BJ. Dietary tyramine and other pressor amines in MAOI regimens: review. J Am Diet Assoc 1986;86(8):1059-1064.
- Daniel K. Hall-Flavin, M.D. MAOIs and diet: Is it necessary to restrict tyramine? Mayo clinic, 2008.
Member Comments