10 Foods High in Tyramine to Limit if You’re on MAOIs
The dos and don’ts of taking medications can be confusing, but there are good reasons for your doctor’s orders. If you’re taking a monoamine oxidase inhibitor (MAOI) to help treat depression or Parkinson’s disease, it’s important to know that the drug can interact with an amino acid called tyramine.
This article explains the basics of tyramine and MAOIs, including how both work in the body and which foods are highest in tyramine.
What Is Tyramine and How Does It Work in the Body?
Tyramine is an amino acid that the body naturally produces. It also occurs in certain foods.
The amino acid is involved in blood pressure control in the body. Tyramine can raise blood pressure levels, but the body has a system for breaking down and excreting excess tyramine thanks to an enzyme called monoamine oxidase.
In addition to breaking down tyramine, monoamine oxidase also removes neurotransmitters like dopamine, serotonin, and norepinephrine from the body. This can be problematic when they’re not functioning correctly, as can happen in depression or Parkinson’s disease. MAOIs aim to address this.
What Are MAOIs?
MAOIs are a class of drugs that includes medications such as the following:
isocarboxazid (Marplan)
phenelzine (Nardil)
tranylcypromine (Parnate)
selegiline (Emsam, Zelapar, Eldepryl), a skin patch
These inhibit the actions of the monoamine oxidase enzyme. While this can be helpful for maintaining healthy dopamine and serotonin levels in depression, it also means that tyramine may build up in the bloodstream.
Some reports suggest that, for those taking MAOIs, even consuming as little as 10 to 25 milligrams (mg) of tyramine may trigger adverse reactions, including increased blood pressure, headaches, and, rarely, life-threatening complications such as brain bleeds. So, it’s important to avoid or limit high-tyramine foods while taking MAOIs and for a few weeks after stopping them.
Doctors don’t often prescribe MAOIs, due to the risks associated with this class of drugs, usually recommending them only if other types of antidepressants have not been effective. The lowest-dose selegiline skin patch may not carry the same risk of side effects as other MAOIs, meaning you might not need to restrict tyramine intake. However, ask your doctor, to be on the safe side.
Some people are more sensitive to tyramine than others, regardless of whether they’re taking an MAOI. Because tyramine constricts and dilates blood vessels, it may be a migraine trigger for those living with migraine. A doctor may recommend eating fewer tyramine-rich foods, to see if it helps reduce the severity or frequency of your headaches.
High-Tyramine Foods List
Tyramine naturally occurs in small amounts in some foods, including:
Chicken liver
Sausage
Turkey
Salami
Bananas
Raisins
Figs
Avocados
Fava beans
But the compound also forms as a result of fermenting, pickling, and aging foods and drinks.
As an amino acid called tyrosine breaks down in aged food products, tyramine production increases. That’s why aged cheeses, cured meats, and pickled fish are considered some of the most tyramine-rich foods.
Most people taking MAOIs will need to minimize or avoid foods and drinks that are significantly high in tyramine. Avoid the following foods if you’re taking an MAOI and following a tyramine-free diet.
1. Strong and Aged Cheeses
Cheese is one of the richest dietary sources of tyramine. In fact, adverse reactions to excessive tyramine have been dubbed “the cheese effect.”
Aged cheeses like cheddar, Swiss, Parmesan, blue cheese, and Camembert are the highest in tyramine, thanks to the way they’re processed.
2. Cured, Smoked, and Processed Meats
We should all limit the amount of processed meat in our diets, but people taking MAOIs should be extra cautious when it comes to these animal proteins.
Processed and cured meat products like salami, sausage, pepperoni, and hot dogs are all rich in tyramine. Choose fresh proteins like wild salmon, grass-fed lean beef, or organic chicken breast instead.
3. Pickled and Fermented foods
Fermented foods are an essential component of a gut-healthy diet, but pickled and fermented products like herring in brine, sauerkraut, and kimchi are high in tyramine.
If you’re taking an MAOI, consider showing your gut some love with a probiotic supplement and high-fiber foods like legumes instead. Doing so will help support your good gut bugs — without the tyramine troubles.
4. Sauces
Some flavor enhancers are high in tyramine. Take soy sauce, for example. The condiment is traditionally made from fermented soybeans, and fermentation increases the tyramine content.
Other high-tyramine sauces include fish sauce and teriyaki sauce.
5. Soy Products
Soybean products like miso, tofu, and tempeh all involve fermentation in the production process. This delivers more tyramine, due to the production method.
6. Yeast Extracts
Though not a common food staple in the United States, savory spreads like Vegemite and Marmite, which are made from yeast extracts, are also high in tyramine.
7. Alcohol
Alcoholic beverages are also on the danger list for those taking MAOIs. Alcoholic beverages like tap and homemade beers, red wine, sherry, and liqueurs are among the highest in tyramine. Commercial wines and bottled, pasteurized beers may not be off the menu, however, but remember that moderation is key.
8. Less-Than-Fresh Animal Proteins
Meat, poultry, or fish that has been stored in the fridge for more than three or four days is higher in tyramine than fresher options. Be sure to cook fresh proteins ASAP to keep their tyramine content in check. Your doctor may recommend sticking to fresh foods while you’re taking MAOIs.
9. Sourdough Bread
When we think of fermented foods, our minds usually skip to products like kimchi and kombucha. But sourdough bread is a product of yeast fermentation, which means it also contains tyramine.
Choose unfermented breads like a seedy whole-wheat bread for a high-fiber replacement.
10. Caffeinated Drinks
You may need to limit caffeinated drinks like coffee, tea, and colas if you’re taking an MAOI, as these also contain tyramine. Talk to your doctor about how much caffeine is safe to drink daily while on MAOIs.
Low-Tyramine Foods
There are plenty of low-tyramine foods and beverages you can enjoy regularly. Some examples include:
Dairy products: Yogurt, milk, ice cream, and cheeses made from pasteurized milk, like cottage cheese, ricotta, and cream cheese, are safe.
Fresh proteins: Freshly bought and prepared meat, poultry, fish, and eggs are low in tyramine.
Beans and peas: All beans and peas — except for fava and broad beans, which are naturally higher in tyramine — are safe.
All fresh, frozen, or canned fruits and vegetables, except those listed above: Be sure to eat frozen or canned foods immediately after opening or cooking them, as the tyramine content increases the longer they sit around.
Pasta: All pasta, including spaghetti, ravioli with permitted ingredients, and egg noodles are safe.
Condiments: You can still eat ketchup, barbecue sauce, mustard, and salad dressings.
If you have any doubt about whether or not a food contains too much tyramine, leave it on the plate and check with your doctor first. And if you don’t know whether a food is expired or still safe to eat, avoid taking unnecessary risks and toss it.
The Takeaway
If you’re taking monoamine oxidase inhibitors for depression or Parkinson’s disease, you may need to avoid or limit high-tyramine foods. These can lead to dangerous spikes in blood pressure when combined with MAOIs.
Tyramine-rich foods include aged cheeses, cured meats, fermented goods, and certain alcohols.
Choose lower-tyramine food options like fresh meats, pasteurized cheeses, and unfermented grains to safely manage your diet while on these medications.
If you are unsure about specific food choices, consult with your healthcare provider promptly to avoid potential health risks.
