Posted by Elizabeth on August 17, 2001, at 13:43:12
Hi. A couple of people have requested that I repost the dietary restrictions that I followed while taking MAOIs. Please don't take this as gospel; it's what worked for me and it's based on some fairly meticulous library research (I can provide a reading list for anyone who's interested). A lot of the "menus" that get handed out by pharmacies, hostpials, doctors, etc. are not very accurate because they are out of date and place extreme and unnecessary restrictions on what you can eat. This results in a number of problems. Many people are scared off by long, intimidating lists of restrictions. In other cases, a person will discover that s/he can "cheat" on some of the foods (the ones that really shouldn't be on the list) and will therefore take the entire list less seriously. There are some things that you definitely should avoid, but they are relatively few.
So, here it is -- a list of some things that I felt merited avoidance, and others that I felt were safe (and had no problems with, of course):
WINE is fine. Some people may get histamine-related headaches from it and think they are having a hypertensive episode when they are not.
BOTTLED BEERS are usually fine (American and Canadian ones are the best studied).
TAP BEER should be avoided.
Most AGED CHEESES are out. Of note, the mozzarella generally used on most pizzas has been found to be okay. So unless it's some weird exotic pizza with sharp cheeses (feta, cheddar, fontina) it should be okay to eat pizza. (In general, cheeses described as "sharp" are the most dangerous ones.) Ricotta cheese, cottage cheese, cream cheese, and "pasteurized process cheese food" (American cheese -- the cheesiest kind) are okay as well. In regard to the intermediately-aged cheeses, I personally had no problem with jack or brie in moderation. I would be careful if you're going to try this, though, and it's not something I'm willing to say is definitely safe.
OTHER DAIRY PRODUCTS, such as milk, yogurt, and sour cream, are generally safe as long as they are fresh.
SOY FOODS are controversial: one sample of soy sauce was reported to have quite a lot of tyramine in it, but there aren't any documented interactions. My experience has been that a little bit of soy sauce is okay. I would avoid other soy products, such as soy milk and tofu. The Taiwanese dish called "stinky tofu" is probably right out. < g >
Similarly, SAUERKRAUT has been found to contain a large amount of tyramine in some analyses, but there aren't any reactions documented that were associated with sauerkraut.
PROTEIN-CONTAINING FOODS that have passed the expiration date or that may have been stored improperly should be avoided. Fresh milk, meat, etc. are okay. One exception that I make, just because there have been so many problems reported with it, is LIVER; it seems possible that the proteins in liver are especially readily broken down to tyramine (perhaps they include more tyrosine than other proteins do, or perhaps the bacteria that turn tyrosine into tyramine are fond of liver).
Certain AGED MEATS, such as salami, bologna, and some sausages, may be problematic. Err on the side of caution. Some telltale words to look for are "aged," "smoked," "air-dried," and "fermented."
PICKLED HERRING itself isn't a problem, just don't eat the brine (yuck!).
To many people's relief, CHOCOLATE is fine. (If my experience with carb cravings on phenelzine is any indication, it's fine in *huge* amounts!)
Some miscellaneous peculiar foods, such as FAVA BEAN PODS and BANANA PEELS, also cause problems. Shouldn't be a major issue for most people. Watch out for Middle Eastern cuisine, which sometimes contains fava beans. MISO SOUP and other Oriental soup stocks have also been reported to cause problems.
I hope that people find this helpful. As I said, I can provide a list of references if anyone is interested.