TYRAMINE SENSITIVITY
A sensitivity to tyramine is most common in individuals who
1. Are taking monoamine oxidase (MAO) inhibiting drugs
2. Suffer from migraine headaches
3. Suffer from chronic urticaria
For persons who are taking monoamine oxidase inhibiting drugs, a tyramine -restricted diet is essential. However, these people will not have a lot of food restrictions if they have no previous history of tyramine sensitivity.
TYRAMINE IS PRESENT IN A NUMBER OF FOODS, PARTICULARLY:
| ♦ Aged cheeses |
| ♦ Raspberries |
| ♦ Yeast extract |
| ♦ Bananas |
| ♦ Chicken liver |
| ♦ Red plums |
| ♦ Wines (especially red) |
| ♦ Avocados |
| ♦ Beer |
| ♦ Eggplant |
| ♦ Other fermented beverages |
| ♦ Tomatoes |
| ♦ Vinegar and pickles |
Cause of Tyramine Sensitivity
Suppression or relative deficiency of the monoamine oxidase enzyme system that normally breaks down tyramine in the body allows tyramine to rise to a level that results in symptoms. It is excessive undegraded tyramine that causes the symptoms.
A tyramine-restricted diet is especially important for persons taking monoamine oxidase (MAO) inhibitors as therapy. Symptoms indicating excessive tyramine in these people include:
♦ Hypertension (increased blood pressure)
♦ Tachycardia (increased heart rate)
♦ Severe headache
♦ Cardiac failure
Medications that are MAOs include:
♦ Hydrazines (used as antidepressants)
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
♦ Nonhydrazines
- Pargyline (Evtatin, Eutanyl)
- Tranylcypromine (Parnate)
- Selegiline (Deprenil, Deprenyl, Eldepryl) (used for treatment of Parkinson’s disease)
♦ Antibiotics
- Isoniazid (anti-tuberculosis drug)
Note: Only Parnate, Nardil, and Marplan are in common use at present. The requirement for a tyramine-restricted diet for persons using other MAO inhibiting drugs will be decided by the physician on an individual basis.
OTHER SYMPTOMS REPORTED TO BE DUE TO A SENSITIVITY TO TYRAMINE INCLUDE
| ♦ Rapid heartbeat |
| ♦ Clamminess |
| ♦ Itchiness |
| ♦ Migraine headache |
| ♦ Hot feeling |
| ♦ Non-migraine headache |
| ♦ Redness of skin (flushing) |
| ♦ Light-headedness |
| ♦ Sweating |
| ♦ Hives |
| ♦ Chills |
The Tyramine-Restricted Diet
For those who are experiencing chronic urticaria or migraine headaches that are considered to be the result of tyramine sensitivity, a reduced tyramine diet is advisable: The response to tyramine is dose-dependent, and the amount of tyramine in foods that causes an adverse reaction will depend on individual tolerance. The number of foods to be restricted initially for these people is usually more extensive than for those who are taking MAO inhibiting drugs, since foods containing lower levels of tyramine are included. Table The tyramine-restricted diet provides details of a tyramine-restricted diet for people who suspect they are intolerant of tyramine.
The Histamine- and Tyramine-Restricted Diet
Some people find that their migraine headaches diminish significantly in severity and frequency when they avoid all food sources of both histamine and tyramine. Table The histamine-andtyramine-restricted diet provides information for such a diet. Four weeks on this diet should be sufficient for a person to determine whether this will provide relief of his or her migraines.
Table The tyramine-restricted diet
| Milk and
Milk Products Breads and Cereals |
• Plain pasteurized milk
• Ricotta cheese • Plain cream cheese • Any pure flour or grain • Limited amounts of yeast-risen breads, including bread, pita, buns, croissants, pizza, English muffins, and crumpets • Baking-powder-leavened products such as biscuits, quick breads, soda bread, scones, and muffins • Cookies, pies, etc., made with allowed ingredients • Breakfast cereals with allowed foods, including - Puffed rice and wheat - Corn flakes - Shreddies - Shredded Wheat - Plain oats and oatmeal - Plain Cream of Wheat -All plain grains • Plain crackers with allowed ingredients: - Grissol Melba Toast - RyVita - Rye Krisp • Rice and pasta dishes with allowed ingredients |
• All other dairy products
• Products made with restricted ingredients • Excessive quantities of baked goods with yeast • Breakfast cereals, like muesli and granola, with restricted nuts and fruit • Plain crackers with restricted ingredients • All packaged rice and pasta meals with “flavor packets” |
| Vegetables | • All pure fresh and frozen
vegetables and juices except those listed at right |
• Any over-ripe vegetables
• Any pickled vegetables • Avocado • Broad beans • Green peas • Potato • Sauerkraut • Spinach • Sweet potato • Tomato • All prepared vegetables with restricted ingredients • Most commercial salad dressings |
| Fruit | • All pure fresh and frozen
fruit and juices, except those listed at right • Fruit dishes made with allowed ingredients |
• Any over-ripe fruit
• Banana • Plums • Prunes • Raisins • Raspberries • Fruit dishes, jams, juices with restricted ingredients |
| Meat, Poultry,
and Fish |
• All pure, freshly cooked meat,
poultry, and fish except what is listed at right |
• Any leftover meat, poultry, or
fish and foods containing them • Dry fermented sausages: - Bologna - Pepperoni - Salami • Oysters • Smoked or pickled fish or fish roe (eggs) • Smoked salmon • Pickled herring • Lox • Caviar |
| Eggs | • All plain eggs | • All prepared with restricted foods |
| Legumes | • All plain legumes except
those listed at right • Pure peanut butter |
• Soy beans, tofu
• Fermented soy products: - Soy sauce - Fermented bean curd - Soybean paste - Shrimp paste - Chili soybean paste |
| Nuts and
Seeds Fats and Oils |
• All plain nuts and seeds
except those at right • Pure butter • Margarine • Pure vegetable oils • Homemade salad dressing with allowed ingredients • Lard and meat drippings • Homemade gravy |
• Walnuts
Pecans • Commercial salad dressings with restricted ingredients • Commercial gravies |
| Spices and
Herbs |
• All fresh, frozen, or dried
herbs and spices |
• Seasoning packets
• Commercial packaged foods labeled with “spices” or “flavoring” |
| Sweets and
Sweeteners |
• Sugar, honey, molasses
• Maple syrup, corn syrup • Icing sugar • Pure jams, jellies, marmalades, and conserves made with allowed ingredients • Plain artificial sweeteners • Homemade sweets with allowed ingredients |
• Chocolate
• Cocoa beans • Cocoa • Spreads with restricted ingredients |
| Other | • Baking powder
• Baking soda • Cream of Tartar • Plain gelatin • Homemade relishes with allowed ingredients • Small amounts of baker’s yeast • All vinegars |
• Flavored gelatin
• Prepared pickles and relishes with vinegar • Yeast and meat extracts: - Bovril -Oxo - Vegemite - Brewer’s yeast - Nutritional yeast |
| Beverages | • Plain milk
• Pure juices of allowed fruits and vegetables • Plain and carbonated drinks • Tea, herbal tea • Coffee |
• Other dairy drinks
• Fruit drinks, and cocktails with restricted ingredients • Cola drinks • Cider • Beer, including nonalcoholic beer • Wine (especially red) • Vermouth Note: Some alcoholic drinks tested had no detectable tyramine. These include whiskey, gin, and vodka, but not all brands have been tested. The recommendation is to eliminate all alcoholic beverages to see if symptoms will subside with their removal. |
Table The histamine-andtyramine-restricted diet
| Type of Food | Foods Allowed | Foods Restricted |
| Milk and
Milk Products |
• Plain pasteurized milk
from any animal • Milk products made without microbial cultures such as - Panir - Mascarpone * - Ricotta* * Read the labels carefully to ensure no microbial cultures are included. • Ice cream free from any restricted ingredient • Cream |
• Fermented milk products from
any animal, such as - Cheese of all types - Cottage cheese - Processed cheese - Cream cheese - Sour cream - Buttermilk -Yogurt - Kefir • And any other fermented milk products • Foods made with milk products other than those allowed |
| Grains,
Cereals, Breads, and Other Baked Products |
• Any pure, unbleached
flour or grain • Baking-powder-leavened products such as - Biscuits - Quick breads - Soda bread - Scones - Muffins • Homemade or purchased baked goods made with allowed ingredients • Crackers without yeast, such as Triscuit • Breakfast cereals with allowed ingredients including any grain without artificial colors or preservatives |
• Yeast-risen breads and
baked products such as: - Bread - Pizza dough - Buns - Pita bread - Croissants - English muffins - Crumpets - Crackers with yeast (read labels) such as Ritz, Saltines • Products made with restricted ingredients, such as -Anise -Artificial colors - Artificial flavors - Bleached flour - Cheese - Chocolate - Cinnamon - Cloves - Cocoa - Margarine - Preservatives - Restricted fruit including jams and jellies made with these fruits • Baking mixes • Dry dessert mixes • Any food made with or cooked in oils with hydrolyzed lecithin, Butylated Hydroxyanisole , Butylated Hydroxytoluene • Breakfast cereals containing restricted ingredients |
| Vegetables | • All pure, fresh, or frozen
vegetables and their juices except those in the “restricted” columns |
• Potato
• Avocado • Broad beans • Green beans • Eggplant (aubergine) • Pumpkin • Sauerkraut • Spinach • Sweet potato • Tomato • Over-ripe vegetables • Pickled vegetables • Packaged salad mixes • Packaged peeled vegetables • Most commercial salad dressings with vinegar, artificial color, flavor, or preservatives |
| Fruit | • All pure, fresh, or frozen fruit
and their juices except those in the “restricted” columns • Allowed fruits include - Melons such as cantaloupe (rock melon), honeydew, watermelon • Other fruits such as -Apple - Pear -Fig - Kiwi - Mango - Passion fruit - Rhubarb - Starfruit - Longans - Lychees • Fruit dishes made with allowed ingredients |
• Lemon
• Lime • The following fresh, frozen, and canned fruits and their juices: - Berries such as blackberries, blueberries, cranberries, gooseberries, loganberries, raspberrires, strawberries - Stone fruits such as apricots, cherries, nectarines, peaches, plums, prunes - Citrus fruits such as oranges and grapefruits - Other fruits such as bananas, grapes, currants, dates, papayas (pawpaws), pineapples, raisins • Fruit dishes, jams, or juices made with restricted ingredients • Any over-ripe fruit |
| Meat, Poultry,
and Fish |
• Pure, freshly cooked meat
or poultry except those in the “restricted” column • Any freshly caught, gutted, and cooked fish • If raw meat is not cooked immediately, store it in the freezer |
•All shellfish, roe, and caviar
• Any fish that has not been gutted and cooked immediately after being caught • Commercially canned fish • All processed meats such as - Pepperoni - Salami - Bologna - Weiners (hot dog) • All pickled meats, eggs, fish |
| Legumes | • All plain legumes except those
in the “restricted” column, such as - Lima beans - Green peas - Sugar peas • Dried beans and peas, such as - Chickpeas (garbanzo beans) - Pinto beans - White beans - Navy beans - Black-eyed peas - Black beans - Lentils (red, yellow, brown) - Split peas - Peanuts - Pure peanut butter |
• Red beans
• Soybeans • Tofu • Fermented soy products such as: - Soy sauce - Fermented bean curd - Soybean paste - Shrimp paste - Chili soybean paste - Miso |
| Nuts and Seeds | • All plain nuts and seeds and
their flours and butters except those in the “restricted” column |
• Walnuts
• Pecans |
| Fats and Oils | • All cold-pressed oils stored
in the refrigerator |
• Processed oils containing
preservatives such as Butylated Hydroxyanisole and Butylated Hydroxytoluene |
| Spices and
Herbs |
• All fresh, frozen, or dried
herbs and spices except those in the “restricted” column |
•Anise
• Cinnamon • Cloves • Curry powder • Hot paprika (cayenne) • Nutmeg • Seasoning packets with restricted ingredients • Commercial packaged foods labeled with “spices” or “flavoring” |
| Sweets and
Sweeteners |
• Pasteurized honey, sugar
• Icing sugar • Maple syrup • Corn syrup • Pure jams, jellies, marmalade, and conserves made with allowed ingredients • Plain, artificial sweeteners • Homemade sweets with allowed ingredients |
• Unpasteurized honey
• Chocolate • Cocoa beans • Cocoa • Flavored syrups • Prepared dessert fillings • Prepared icings/frostings • Spreads with restricted ingredients • Cake decorations • Confectionery • Commercial candies |
| Beverages | • Plain milk
• Pure juices of allowed fruits and vegetables • Plain and carbonated mineral water • Coffee |
• Fruit drinks and cocktails with
restricted ingredients • Cola-type carbonated drinks • Apple cider • All teas, including green tea • All alcoholic beverages • Nonalcoholic beers and wines • All drinks with “flavor” or “spices’ on the label |
| Other | • Baking powder
• Baking soda • Cream of Tartar • Plain gelatin • Homemade relishes with allowed ingredients |
• Baker’s yeast
• All vinegars • Prepared pickles, relishes, ketchup, and mustard containing vinegar • Flavored gelatin • Chocolate and cocoa • Mincemeat • Yeasts of the species Saccharomyces • Brewer’s yeast • Nutritional yeast • Yeast and meat extracts, e.g., Bovril, Marmite, Oxo, Vegemite |
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