TYRAMINE-FREE DIET

What do I need to avoid?

To avoid tyramine ask about ingredients at restaurants and others’ homes, and read food labels. The following list is not complete. Consult with a healthcare professional before making any significant changes to your diet. Items listed below that are marked with an asterisk (*) contain high to very high amounts of tyramine.

Dairy products to avoid:

• Aged cheeses*: Blue, Boursault, Boursin, Brick (natural), Brie, Camembert, Cheddar, Colby, Emmenthaler, Gruyere, Mozzarella, Parmesan, Provolone, Romano, Roquefort, Stilton, and Swiss
• American cheese
• Gouda
• Processed cheese
• Sour cream
• Yogurt*

Alcoholic beverages to avoid:

• Ale
• Chinati*
• Distilled spirits
• Draft beer (including some non-alcoholic beers)*
• Port*
• Reisling*
• Sauterne*
• Sherry*
• Vermouth*

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:

• Canned meats*
• Caviar*
• Commercial gravies or meat extracts*
• Fermented (hard) sausages*: Bologna, pepperoni, salami, summer sausage, Genoa salami
• Fish (unrefrigerated, fermented)
• Game meat*
• Liver (beef or chicken)
• Meat tenderizer
• Pickled herring*
• Potentially spoiled meat, poultry, or fish
• Salted, dried fish, such as herring, cod, or camlin*
• Shrimp paste

Fruits and vegetables to avoid:

• Avocados (especially overripe)*
• Bananas (contain dopamine)
• Bean curd
• Chinese pea pods*
• Chinese vegetables, mixed*
• Eggplant*
• Fava beans (overripe; contain dopamine)*
• Figs (overripe)*
• Green bean pods*
• Italian flat beans*
• Miso soup
• Raisins (permitted on diets not restricted in dopamine)
• Red plums*
• Sauerkraut*
• Soybean products
• Spinach
• Tofu
• Tomatoes
• Yeast extracts*: Marmite, Vegemite, etc.

Miscellaneous foods to avoid:

• Bouillon and other soup cubes*
• Breads or crackers containing cheese*
• Caffeine: coffee, tea, colas
• Chocolate*
• Phenylethylamine
• Protein-containing foods that have been stored improperly, or that may be spoiled*
• Protein extracts*
• Soups containing items that must be avoided*
• Soy sauce*
• Yeast concentrates or products made with them*
• Yeast breads, homemade with substantial quantities of yeast*

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 MAO inhibitors. 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. All soybean products should be avoided.

Herbs 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.