Tyramine is a natural substance formed from the breakdown of protein as food ages. It is found in aged, fermented, or spoiled foods. Generally speaking, the longer a high-protein food ages, the greater the potential tyramine content. Aged cheeses, spoiled meats, some aged and cured meats, Marmite yeast extract, sauerkraut, fermented soybean products (such as soy sauce and miso), broad (fava) bean pods, and draft (tap) beer have the highest levels of tyramine.
Why do people follow this diet?
A tyramine-free diet is prescribed for people who are sensitive to tyramine, such as migraine sufferers, or those taking prescription monoamine oxidase inhibitor (MAOI) antidepressants, such as phenelzine (Nardil®). Under normal circumstances, tyramine and dopamine are metabolized to their harmless metabolites by the enzyme monoamine oxidase (MAO). Drugs that inhibit MAO also inhibit the metabolism of tyramine and dopamine, leading to elevated levels of these substances in the bloodstream.
What are the symptoms?
Excessive levels of tyramine can cause headache, palpitations, nausea, vomiting, and hypertensive crisis (dangerously high blood pressure).
What do I need to avoid?
To avoid tyramine, ask about ingredients and freshness at restaurants and others’ homes, and read food labels. The following list is not complete, but contains the most likely food sources of significant (six or more milligrams) tyramine content. Consult with a healthcare professional before making any major changes to your diet.
Older lists of foods containing tyramine have been re-evaluated by researchers who question the accuracy of initial reports of tyramine content in food or reactions to food by people taking MAOIs. Many foods have a low tyramine content when fresh, but their tyramine levels rise if they are allowed to age or spoil. Other foods may only contain tyramine in certain batches, but not others. If you consume a food from the following list and do not experience a reaction, do not assume that food will always be safe. Items listed below that are marked with an asterisk (*) usually contain high to very high amounts of tyramine, and most authorities agree they should be avoided. The remaining items listed may only rarely contain significant amounts of tyramine when consumed in typical portions, and may be hazardous only when either spoiled or when eaten in large amounts.
Dairy products to avoid:
Aged cheeses*: Blue, Boursault, Boursin, Brick (natural), Brie, Camembert, Cheddar, Colby, Emmenthaler, Gruyere, Parmesan, Provolone, Romano, Roquefort, Stilton, and Swiss
Note: Dairy products not marked with an asterisk (*) should be safe when eaten fresh in moderate amounts.
Alcoholic beverages to avoid:
Bottled or canned beer and ale (including non-alcoholic varieties)
Red or white wine
Draft (tap) beer and ale*
Note: Some experts believe wine and domestic bottled or canned beers are safe when consumed in moderation. Consult your doctor if you are taking MAOI drugs or have migraine headaches and wish to consume wine or domestic beer.
Meat and fish to avoid:
Commercial gravies or meat extracts
Fermented (hard) sausages*: Bologna, cacciatore, pepperoni, salami, summer sausage, Genoa salami, etc.
Fish (unrefrigerated, fermented)
Liver (beef or chicken)
Meat prepared with meat tenderizer
Potentially spoiled meat, poultry, or fish
Salted, dried fish, such as herring, cod, or camlin
Note: Meat and fish products not marked with an asterisk (*) should be safe when eaten fresh in moderate amounts.
Fruits and vegetables to avoid:
Avocados (especially overripe)
Bananas (contain dopamine, pulp is okay)
Fava beans (contain dopamine)*
Tofu (if more than a few days old)
Miscellaneous foods to avoid:
Bouillon and other soup cubes
Breads or crackers containing cheese
Protein-containing foods that have been stored improperly, or that may be spoiled*
Soups containing items that must be avoided*
Yeast concentrates or products made with them (baker’s and brewer’s yeast is okay)*
Yeast extracts*: Marmite, Vegemite, etc.
Two cases of a possible interaction between aspartame (NutraSweet®) and phenelzine, an MAOI drug, have been reported.
An analysis of pizzas from large commercial chain outlets found no significant tyramine levels in any of the pizzas tested, including those with double pepperoni and double cheese. The authors of this study concluded that pizzas from large chain commercial outlets are safe for consumption with MAOIs. However, they recommended caution when ordering from smaller outlets or with gourmet pizzas that may use aged cheeses.
The same study found marked variability in the tyramine content of soy products, including significant amounts of tyramine in tofu when stored for a week, and high tyramine content of one of the soy sauces. The authors recommend avoiding all soybean products.
Although St. John’s wort contains chemicals that bind MAOI in test tubes, the action of St. John’s wort is not thought to be due to MAOI activity. However, because St. John’s wort may have serotonin reuptake inhibiting action (similar to the action of drugs such as fluoxetine [Prozac®]), it is best to avoid using of St. John’s wort with MAOI drugs. Ephedra (Ephedra sinica), ginseng (species not specified), and Scotch broom (Cytisus scoparius) are also known to interact with phenelzine and should be avoided by anyone taking an MAOI drug.
The following foods range from very low to low in tyramine and can be consumed in moderation.
Note: These foods are not all tyramine-free. The quantity you eat will affect the amount of tyramine you consume.
Beverages, breads, and fats (all, except those specifically to be avoided)
Cottage cheese, ricotta, cream cheese, soft farmer’s cheese, mozzarella cheese, processed cheese slices, sour cream, yogurt, and milk
Meat, poultry, fish, and shellfish (fresh or frozen)
Vegetables and fruits (most, except those specifically to be avoided)
Oranges: limit to one small orange per day (1 mg of tyramine)
Tomatoes: limit to 1/2 cup [100 grams] per day
Information provided by Health Notes
Eric R. Braverman, M.D.
Dr. Braverman is a Summa Cum Laude and Phi Beta Kappa graduate of Brandeis University and NYU Medical School, did brain research at Harvard Medical School, and trained at an affiliate of Yale Medical School. He is acknowledged worldwide as an expert in brain-based diagnosis and treatment, and he lectures to and trains doctors in anti-aging medicine.