August 18, 2022

Tyramine-Free Foods: MAOIs and Diet

If you enjoy wine or aged, fermented, smoked, or pickled foods, then chances are tyramine…

If you enjoy wine or aged, fermented, smoked, or pickled foods, then chances are tyramine shows up in your diet.

Tyramine is an amino acid naturally produced by the breakdown of an amino acid called tyrosine. It’s also present in other foods, plants, and animals (1).

Tyramine is generally safe to consume. However, if you experience migraine headaches or take monoamine oxidase inhibitors (MAOIs), you may have heard that you should limit or avoid tyramine in your diet.

That’s because tyramine can trigger migraine headaches, and it accumulates in your body when you’re taking MAOIs.

People taking these medications need to be conscious of their tyramine intake because the accumulation can cause potentially dangerous side effects such as high blood pressure (2).

This article will cover the relationship between tyramine and MAOIs and offer advice for different ways to limit tyramine in your diet, if you need to do so.

Your adrenal glands generally respond to tyramine by sending catecholamines — fight-or-flight chemicals that act as both hormones and neurotransmitters — into your bloodstream. These messenger chemicals include (3):

  • dopamine
  • norepinephrine
  • epinephrine

The catecholamines give you a boost of energy and, in turn, elevate your blood pressure and heart rate.

Most people consume tyramine-containing foods without experiencing any negative side effects. However, the release of this hormone can cause life threatening blood pressure spikes, especially if you consume tyramine in excess.

summary

Tyramine is a naturally occurring substance found in many foods. It may elevate your blood pressure and heart rate, which can be an issue for some people.

If you’re taking MAOIs or you have migraine, you may benefit from following a tyramine-free diet.

Following a low tyramine diet while taking MAOIs

Tyramine-rich foods might interact with medications or change how they work in your body. For example, certain MAOIs, including some antidepressants and medications for Parkinson’s disease, can cause tyramine buildup.

Excessive tyramine intake may lead to a hypertensive crisis that can be fatal. A hypertensive crisis can occur when your blood pressure is so high that you have a greater chance of stroke or death (4, 5).

If your body struggles to break down amines, such as tyramine and histamine, you may experience allergic-type reactions to small amounts of amines. A doctor or other healthcare professional may say that you’re “amine-intolerant.”

For most people who are amine-intolerant, tyramine’s effects are most obvious when excessive amounts are present. At high enough levels of tyramine, you might experience symptoms like:

  • heart palpitations
  • nausea
  • vomiting
  • headaches

If you think you may be sensitive to tyramine, or if you’re taking MAOIs, report any symptoms to a healthcare professional.

If you’re taking MAOIs and experience the following symptoms, seek immediate medical care:

  • chest pain
  • intense headache
  • blurred vision
  • slurred speech or other symptoms of stroke
  • increasing shortness of breath
  • nausea or vomiting
  • confusion or difficulty thinking

Which MAOIs are used for depression?

When deciding whether to limit tyramine consumption, consider whether you’re taking any of the following medications for the treatment of depression (6):

  • selegiline (Atapryl, Carbex, Eldepryl, Emsam, Zelapar)
  • phenelzine (Nardil)
  • isocarboxazid (Marplan)
  • tranylcypromine (Parnate)

While MAOIs are not the front line of medications preferred for treating depression, those listed above are approved by the Food and Drug Administration (FDA) to treat it (6, 7).

If you and a healthcare professional you work with believe you should discontinue your MAOI, continue a tyramine-free diet for 14 days after stopping the medication.

summary

Tyramine can cause medications to behave differently in your body. If you’re taking MAOIs, you should limit your tyramine intake, as these drugs may cause tyramine to accumulate and lead to life threatening blood pressure spikes.

Some healthcare professionals recommend trying a low tyramine or tyramine-free diet as a treatment for migraine.

The diet’s effectiveness for treating migraine isn’t medically proven. However, if you’d like to try it, the best way to start is to familiarize yourself with low and high tyramine foods, so that you know which to consume and which to limit or avoid.

Keep a migraine and food journal

It might also be a good idea to keep a daily migraine symptom and food journal. This can help you discern any connections between certain foods and your migraine symptoms — whether these foods are high in tyramine or not.

Record the following as you go about your day:

  • what you ate or drank, including water and all other beverages
  • how much you ate or drank
  • what time you ate or drank
  • whether you experienced any migraine-related symptoms

Doing this for a week or two may help you identify clear migraine triggers, as well as any high or moderate-tyramine foods you consume regularly.

Eat the freshest foods possible

Another tip for reducing tyramine in your diet is to eat the freshest foods possible. That’s because tyramine naturally forms as food sits around. While this isn’t an issue for most people, it can be a migraine trigger for some.

To minimize the tyramine content in your food, try the following:

  • Eat, cook, or freeze fresh foods within 24 hours of purchase.
  • Eat cooked foods within 48 hours of cooking.

However, it’s a good idea to speak with a healthcare professional or a registered dietitian before making drastic changes to your diet — especially if you’re taking any medications.

summary

While it’s not medically proven, a tyramine-free diet may reduce symptoms of chronic migraine. To start, it may be helpful to keep a daily journal of all foods and drinks you consume and any migraine symptoms you experience.

If you’re sensitive to tyramine or you’re taking MAOIs, you may want to limit your intake of tyramine-rich foods and beverages to lower your chances of tyramine buildup.

High tyramine foods

Certain foods have high amounts of tyramine, especially foods that are fermented, cured, aged, or spoiled.

Foods that concentrate more than 6 mg of tyramine per serving are considered high in tyramine. Specific foods with high tyramine content include (8, 9, 10):

  • salt-dried fish such as mackerel, cod, and sardines
  • unpasteurized, strong, or aged cheeses such as cheddar, feta, blue cheese, and Gorgonzola
  • casseroles or pizzas made with aged cheeses
  • cured or smoked meats or fish, such as sausage and salami
  • some overripe fruits
  • certain beans, such as fava and broad beans
  • some sauces and gravies, such as soy sauce, teriyaki sauce, fermented fish sauce, and bouillon-based sauces
  • pickled products such as sauerkraut and kimchi
  • sourdough breads, yeast-leavened breads, or breads made with aged cheese or meat
  • fermented soy products such as miso soup, bean curd, and tempeh, as well as forms of tofu that are fermented, such as “stinky tofu”
  • fish or shrimp paste
  • concentrated yeast products such as spreads (Marmite, Vegemite) and brewer’s yeast
  • protein supplements with yeast products
  • improperly stored or spoiled foods
  • mincemeat pie
  • meat tenderizers or foods prepared with meat tenderizers
  • certain alcoholic beverages, such as tap or home-brewed beer, Korean beer, and vermouth

Moderate tyramine foods

Certain foods concentrate moderate amounts of tyramine. If you want or need to limit tyramine, you should eat these only occasionally — no more than three servings of any foods on this list daily — and pay close attention to how you feel.

Some cheeses and dairy products are less tyramine-rich than others, including (8):

Other foods with moderate levels of tyramine include:

  • avocados
  • anchovies
  • raspberries
  • broccoli
  • eggplant
  • citrus (grapefruit, oranges, pineapple, lemons, limes)
  • chocolate
  • some wines
  • nuts, seeds, and nut butters
  • wine vinegar and apple cider vinegar
  • certain red and white wines

You may be able to have some beer or certain other alcoholic drinks. Most bottled beers should be safe to drink in modest amounts, but avoid draft (tap) beer.

Because wines are fermented, you should limit your intake to no more than 4 ounces per day — and be sure to check with a healthcare professional first.

Low- or no-tyramine foods

Fresh, frozen, and canned meats, including poultry and fish, are acceptable for low tyramine diets. You can also include the following:

  • grains, including pasta, bread, cereal, and rice
  • non-aged packaged or luncheon meats (except for salami and other aged or cured meats)
  • non-fermented or pasteurized dairy, such as milk
  • non-fermented or pasteurized cheeses, such as cream cheese, ricotta cheese, and cottage cheese
  • fresh, canned, and frozen fruits and vegetables
  • eggs
  • raisins
  • cooking fats and oils
  • fresh and canned legumes, such as most beans, lentils, and peas (aside from fava beans and broad beans)
  • ketchup, Worcestershire sauce, and most salad dressings (aside from any that contain aged fish products or other fermented foods)
  • coffee, tea, and soft drinks
  • certain liquors, such as bourbon, rum, vodka, and gin

If you decide to drink lower-tyramine liquors, be sure to do so with food. The food will slow down your body’s absorption of any trace tyramine in the liquor.

If you experience side effects from any food or drink — whether it’s high or low in tyramine — discontinue eating or drinking that food or drink, and be sure to mention the reaction to a healthcare professional.

summary

You should avoid high tyramine foods while on a low tyramine diet. Typically, these include aged or fermented foods such as salami and some cheeses. Low tyramine foods include fresh vegetables and fruit, grains, eggs, and non-fermented dairy.

A number of factors influence tyramine content, including when the food was produced, how it was stored, and its age (8).

Even fresh and cooked food naturally develop tyramine as they sit in your refrigerator. Heat does not destroy tyramine, so cooking foods will not affect their tyramine content (8).

If you want to limit your tyramine intake, follow these guidelines:

  • Use extra caution when selecting, storing, and preparing your food.
  • Eat fresh produce within 2 days of purchase.
  • Read all food and drink labels carefully.
  • Avoid spoiled, aged, fermented, or pickled foods, sauces, and condiments.
  • Don’t thaw foods at room temperature. Thaw them in the refrigerator or the microwave instead.
  • Eat canned or frozen foods, including produce, meats, poultry, and fish, right after opening them.
  • Buy fresh meats, poultry, and fish. Eat them the same day or freeze them immediately.
  • Use caution when you eat out, because you don’t know how foods have been stored.

summary

To limit tyramine intake, eat the freshest food possible — ideally within 48 hours of purchase. Eat canned foods immediately after opening. Avoid all aged, fermented, and pickled foods, including fermented sauces, spreads, and pastes.

Tyramine buildup in the body has been associated with migraine headaches and life threatening blood pressure spikes in people who are taking MAOI antidepressants.

If you experience migraine headaches, think you may be intolerant to amines, or take MAOIs, you may want to consider a low tyramine or tyramine-free diet.

Talk with a healthcare professional first and ask them whether this diet would work well for you.

https://www.healthline.com/nutrition/tyramine-free-diets