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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by JadeKelly on March 14, 2009, at 12:02:41
Hey Guys,
I know people are frequently looking for the "current" list of accepted foods. I have been using this diet for 5 months and have not had one food related problem. I have a couple things I've seen elsewhere to be okay to eat/drink that I think are safe as I have them on a regular basis. You will have to decide for yourself: 2-3 bottled Domestic beers IN THE BOTTLE-NO DRAFT, couple glasses of white wine, american, provolone, pepperjack cheeses (just MAKE SURE its not aged), Protien shakes and drinks made with WHEY PROTIEN NOT SOY. If the protien comes from SOY, skip it.
Foods to Avoid with MAOIs
Revised in 1994/See below
From: Saklad@uthscsa.edu (Stephen R. Saklad)
Subject: Re: MAO-I's dietary restrictions
Date: Mon, 28 Nov 1994 23:05:01 -0600On 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,(Anon, 1989;McCabe,1986):
NEW RECOMMENDATIONS/REVISIONSThe 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)
FOODS TO AVOID
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).
Cheese
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).
Fish
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).
Ginseng
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).
Meat
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).
Sauerkraut
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).
Soups
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).
Yeast
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).FOODS TO USE WITH CAUTION
(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).
More than 200 foods contain tyramine in small quantities and have been implicated in reactions with MAOI therapy, however the majority of the previous reactions were due to the consumption of spoiled food. Evidence does not support the restriction of the following foods listed if the food is fresh (McCabe, 1986).
FOODS WITH INSUFFICIENT EVIDENCE FOR RESTRICTION (McCabe, 1986)
anchovies
beetroot
chips with vinegar
Coca Cola
cockles
coffee
corn, sweet
cottage cheese
cream cheese
cucumbers
egg, boiled
figs, canned
fish, canned
junket
mushrooms
pineapple, fresh
raisins
salad dressings
snails
tomato juice
wild game
worcestershire sauce
yeast-leavened bread
Following List Revised by DRUGDEX Editorial Staff
Denver, Colorado 80204, 09/82
Revised by DRUGDEX Editorial Staff, 09/83; 07/85; 07/86; 09/89; 04/93; 01/94MEATS AND FISH:
Liver of all kinds
pate
Pickled herring and other pickled fish
Game (venison, etc.)
Caviar
Snails (escargot)
Salted fish (lox)
Pastrami
Corned beef
Sausages (salami, etc)
BoverilFRUITS AND VEGETABLES:
Pods of broad beans
English beans
Chinese pea pods
Miso and miso soup
Fava beans
Overripe fruit (especially bananas and Avocados)
Raisins and other dried fruits
Pickles of any type
Sauerkraut
Canned FigsDAIRY PRODUCTS:
All cheeses (Except for cream, cottage, farmer and ricotta)
Frozen yogurt (Fresh yogurt is OK up to the expiration date on the container)
Sour creamBEVERAGES:
Red wine
Beer and ale (including alcohol-free)
Champagne
Sherry
Brandy
Liqueurs and fruit brandies
Cognac
(Truly moderate amounts of white wine, gin or vodka are OK)
Over four servings of caffeine-containing drinks such as coffee, cola drinks, etc.
MISCELLANEOUS:
Soy sauce
Brewers yeast (Bread, cake, cookies etc. are OK as they do not contain brewers yeast)
Marmite
Licorice
Over one ounce of chocolateErowid Note, Mar 2007: It is more accurate to say that tyramine is a metabolic breakdown product of the amino acid tyrosine.
Any protein food, improperly stored or handled, can form pressor amines through protein breakdown. Chicken and beef liver, liver pate, and game generally contain high amine levels due to frequent mishandling. Game is often allowed to partially decompose as part of its preparation. Ayd (1986) reported that the freshness of the food is a key issue with MAOIs and that as long as foods are purchased from reputable shops and stored properly, the danger of a hypertensive crisis is minimal. Some foods should be avoided, the most dangerous being aged cheeses and yeast products used as food supplements (Gilman et al, 1985).
With appropriate dietary restrictions, the incidence of hypertensive crises has decreased to approximately 4% (Zisook, 1985). Treatment of a hypertensive reactions includes the=7F administration of phentolamine (Anon, 1989) 2.5 to 5 milligrams intravenously (slow) titrated against blood pressure (Zisook,=7F 1985; Lippman & Nash, 1990). One report has suggested that the use of sublingual nifedipine 10 milligrams was effective in treating 2 hypertensive reactions following the ingestion of a tyramine-containing food in a patient receiving MAOI therapy (Clary & Schweizerr, 1987). Chlorpromazine also has alpha-blocking properties and has been recommended as an agent for discretionary use (patient-initiated treatment) in the setting of dietary indiscretion (Lippman & Nash, 1990).
CONCLUSION:
Dietary restrictions are required for individuals receiving monoamine oxidase inhibitor therapy to prevent a hypertensive crisis and other side effects. The foods listed in the dietary restrictions have been categorized into those foods that must be avoided, foods that may be ingested in small quantities, and those foods that were previous implicated in reactions but upon analyses of fresh samples only a small tyramine content was identified and should be safe to consume if freshness is considered.
REFERENCES:
Anon: Foods interacting with MAOI inhibitors. Med Lett Drug Ther 1989; 31:11-12.
Ayd FJ: Diet and monoamine oxidase inhibitors (MAOIs): an update. Int Drug Ther Newslett 1986; 21:19-20.
Brown CS & Bryant SG: Monoamine oxidase inhibitors: safety and efficacy issues. Drug Intell Clin Pharm 1988; 22:232-235.
Clary C & Schweizer E: Treatment of MAOI hypertensive crisis with sublingual nifedipine. J Clin Psychiatry 1987; 48:249-250.
Da Prada M, Zurcher G, Wuthrich I et al: On tyramine, food, beverages and the reversible MAO inhibitor moclobemide. J Neural Transm 1988; 26(Suppl):31-56.
Gilman AG, Goodman LS & Rall TW et al (Ed): Goodman and Gilman's The Pharmacological Basis of Therapeutics, 7th ed., Macmillan Publishing, New York, NY, 1985.
Lippman SB & Nash K: Monoamine oxidase inhibitor update. Potential adverse food and drug interactions. Drug Safety 1990; 5:195-204.
McCabe BJ: Dietary tyramine and other pressor amines in MAOI regimens: a review. J Am Diet Assoc 1986; 86:1059-1064.
Stockley I: Alcohol-free beer not safe for MAOI patients. Pharm J 1993; 250:174.
Zisook S: A clinical overview of monoamine oxidase inhibitors. Psychosomatics 1985; 26:240-251.
AUTHOR INFORMATION:
Theodore G Tong, Pharm D/C Hansen
Assistant Clinical Professor of Pharmacy
University of California
San Franscisco, California 94143
10/79
Design © 1995-2009 Erowid.org. Content © respective copyright holders.
Posted by JadeKelly on March 14, 2009, at 12:20:52
In reply to Current List: Foods to avoid with MAOI's, posted by JadeKelly on March 14, 2009, at 12:02:41
To Be Clear: These Foods Are RESTRICTED!!
MEATS AND FISH:
Liver of all kinds
pate
Pickled herring and other pickled fish
Game (venison, etc.)
Caviar
Snails (escargot)
Salted fish (lox)
Pastrami
Corned beef
Sausages (salami, etc)
Boveril
FRUITS AND VEGETABLES:
Pods of broad beans
English beans
Chinese pea pods
Miso and miso soup
Fava beans
Overripe fruit (especially bananas and Avocados)
Raisins and other dried fruits
Pickles of any type
Sauerkraut
Canned Figs
DAIRY PRODUCTS:
All cheeses (Except for cream, cottage, farmer and ricotta)
Frozen yogurt (Fresh yogurt is OK up to the expiration date on the container)
Sour cream*I eat some fresh sour cream with out problem
Posted by Phillipa on March 14, 2009, at 12:34:05
In reply to Re: Current List: Foods to avoid with MAOI's, posted by JadeKelly on March 14, 2009, at 12:20:52
A poster a while ago had a stroke like reaction and will never be the same on nardil. Don't know if a food was implicated. Hope your're doing well. Phillipa
Posted by JadeKelly on March 18, 2009, at 1:37:31
In reply to Re: Current List: Foods to avoid with MAOI's » JadeKelly, posted by Phillipa on March 14, 2009, at 12:34:05
> A poster a while ago had a stroke like reaction and will never be the same on nardil. Don't know if a food was implicated. Hope your're doing well. Phillipa
Phillipa, I feel my thread to help educate people on proper foods with MAOI's was not an appropriate place for your post.
However, now that its done, lets use it to educate on that subject of not using washout periods.
I was not here when that happened but you were and I'm surprized that you don't remember what happened. But since you've brought it up, I'll explain for others.
First, it had nothing to do with food, and I believe that was never even mentioned as a possibility. It happened to poster Pheonix1 in late 2007, as a result of running out of Nardil. For reasons unknown, he immediately switched to Parnate for 2-3 days with out any washout. He then restarted the Nardil. This caused problems obviously. No washout periods. He, and his PDoc, knew you can't do this. I'm not clear on who made that bad decision. I feel for Pheonix, for what he went through, I'm not sure what his condition was when he started posting again. He sounded lucid.
At any rate, I read posts from him after that, he wished he could still take Nardil, as it was the only thing that worked for his depression. He seemed Okay, but I've never talked to him. Did you know him Phillipa?
Anyone wishing to know more about this should search: Pheonix1 Nardil Parnate, just look for his posts. Dec2007-Jan2008
Posted by Cseagraves on March 19, 2009, at 13:14:14
In reply to Current List: Foods to avoid with MAOI's, posted by JadeKelly on March 14, 2009, at 12:02:41
O.K. - a couple of questions.
My whey protein powder is whey protein isolate, but contains soy lecithin. As a matter of fact, I haven't been able to find any whey protein that doesn't contain soy lecithin. So is soy lecithin O.K.?
What's the difference in the a whey protein shake that is allowed and the powdered protein shake that you list below as being not allowed?
My aminos that I take everyday contain 132 mgs of tyrosine and my whey protein shake contains anywhere from 500 to 1000 mgs of tyrosine per serving. Is this o.k. (I always get this tyrosine and tyramine thing mixed up)
I know we can't have soy sauce (or maybe just a little bit), but I am assuming that teriyaki sauce is o.k.?
Thanks,
Courtney
Posted by JadeKelly on March 19, 2009, at 23:39:24
In reply to Re: Current List: Foods to avoid with MAOI's, posted by Cseagraves on March 19, 2009, at 13:14:14
> O.K. - a couple of questions.
>
> My whey protein powder is whey protein isolate, but contains soy lecithin. As a matter of fact, I haven't been able to find any whey protein that doesn't contain soy lecithin. So is soy lecithin O.K.?
>
> What's the difference in the a whey protein shake that is allowed and the powdered protein shake that you list below as being not allowed?
>
> My aminos that I take everyday contain 132 mgs of tyrosine and my whey protein shake contains anywhere from 500 to 1000 mgs of tyrosine per serving. Is this o.k. (I always get this tyrosine and tyramine thing mixed up)
>
> I know we can't have soy sauce (or maybe just a little bit), but I am assuming that teriyaki sauce is o.k.?
>
> Thanks,
>
> CourtneyHey Courtney,
I have lots of things with "soy lethicin". To be honest, I'm not even sure what it is. But I remember checking with my phamacist and she said its ok. I'm not sure if it benign in some way or is always in small amounts.
As for the shakes and drinks, that was part of this list, but as long as the drink, shake, powder, whatever, is getting its protien from Whey and not Soy, I've never had a problem. I know many others drink them as well.
"> My aminos that I take everyday contain 132 mgs of tyrosine and my whey protein shake contains anywhere from 500 to 1000 mgs of tyrosine per serving. Is this o.k. (I always get this tyrosine and tyramine thing mixed up)"Yikes. Me too. You'd have to check elsewhere on that one Courtney. I'm just not sure.
I'm not sure what's in Teriyaki Sauce.
Let me know though, or go ahead and add what you find to the list. I like to err on the side of caution, as I think you do also.
Looks like you've been going through the ringer, I wish I had some helpful advice. Which MAOI are you lookin at? I think you said you wanted to try Marplan again? If you do, good luck!
~Jade
Posted by desolationrower on March 20, 2009, at 23:28:30
In reply to Re: Current List: Foods to avoid with MAOI's » Cseagraves, posted by JadeKelly on March 19, 2009, at 23:39:24
well, i do know wahts in both soy lecithin and teriaki sauce. the former is ok, and the latter will have probably have some tyramine (although, i wouldn't doubt that there is sufficient cheap industrial flavor teriaki that manages to contain no tyramine. if it does exist, it is not going to be worth eating.)
tyrosine is the common amino acid; it is sometimes metabolized by bacteria during fermentation to tyramine.
-d/r
Posted by paulk on March 22, 2009, at 0:06:05
In reply to Re: Current List: Foods to avoid with MAOI's, posted by desolationrower on March 20, 2009, at 23:28:30
I've always wondered why they don't do a titration test with tyramine to see if an individual is at risk. Wouldn't be expensive - most people will have very small risk and those with high risk should at least know how careful they have to be.
Posted by desolationrower on March 22, 2009, at 16:00:09
In reply to Re: Current List: Foods to avoid with MAOI's, posted by paulk on March 22, 2009, at 0:06:05
> I've always wondered why they don't do a titration test with tyramine to see if an individual is at risk. Wouldn't be expensive - most people will have very small risk and those with high risk should at least know how careful they have to be.
i even bought some tyramine, but decided not to test my sensitivity, it seemed like too much work. and if varies on what else you eat.
-d/r
Posted by Questionmark on March 26, 2009, at 16:15:01
In reply to Current List: Foods to avoid with MAOI's, posted by JadeKelly on March 14, 2009, at 12:02:41
Couple brief things:
1 I thought pepperjack was aged, so that is probably a no-no. Could be wrong.
2. I don't think soy protein is all that risky and especially dont think its more risky than whey protein. The risk is the protein breaking down, so they should both be of relatively equal risk right?
Also, i always thought soy and teriyaki (sp?) sauces were fine and only included on previous lists due their occasional containing of MSG and hence free glutamate (which may or may not have negative brain effects but would not cause a hypertensive reaction). But i suppose there is the possibility of tyramine accumulating in the sauce as a result of the breakdown of the soy protein. However i think this is unlikely.
Posted by desolationrower on March 27, 2009, at 2:30:27
In reply to Re: Current List: Foods to avoid with MAOI's » JadeKelly, posted by Questionmark on March 26, 2009, at 16:15:01
soy sauce is basically a bunch of soy and salt put in a barrel and left for a year. exactly where you would find tyramine.
now, if there was significant demand for it, it wouldn't be too hard to produce low-tyramine foods, since different bacteria strains create very different levels of tyramine, but since its basically just all 8 people on MAOIs and a few migraine sufferes who care, its not been done.
-d/r
Posted by jedi on March 27, 2009, at 3:54:37
In reply to Re: Current List: Foods to avoid with MAOI's, posted by desolationrower on March 27, 2009, at 2:30:27
Hi Guys,
Everyone is different but I've been on Nardil for most of eleven years and have not had problems with many of the foods listed in the 1994 paper. The main offender in tyramine reactions is aged cheese. I have never had problems with fairly large quantities of mozzarella or jack cheeses. I have never had a problem with alcohol of any kind. I don't drink tap beer because you never know the condition of the taps and hoses used to dispense it. Chocolate, even in mass quantities has never been a problem. Many Nardil users with the sweet carbohydrate cravings can probably relate to this one. Large quantities of caffeine has never been a problem for me. Many of the foods on the 1994 list, I would never even think of eating. If I'm not sure about a food, I just don't eat it.I did have a tyramine reaction once when I went brain dead and ate some aged swiss, thinking white cheese, OK - WRONG! Actually I had a worse reaction to the niphedipine that I took to lower my blood pressure. My PDOC at the time gave me, as I remember, 10mg bite-and-swallow capsules. This was way too much for me. I ended up spending a night in the hospital on IV fluids because the tyramine reaction was over way before the effect of the 10mg of niphedipine wore off. This caused serious low blood blood pressure. Be very careful with this medication. Many doctors will not prescribe it now. People die from low pressure too. If I ever use it again, it will be 5mg capsules.
Here is the diet I follow:
MAOI diet short list
Posted by Elizabeth on August 17, 2001, at 13:43:12
http://www.dr-bob.org/babble/20010814/msgs/75408.htmlTake care,
Jedi
This is the end of the thread.
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