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
• Gouda

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*
• Port
• 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, cacciatore, pepperoni, salami, summer sausage, Genoa salami, etc.
• Fish (unrefrigerated, fermented)
• Game meat*
• Liver (beef or chicken)
• Meat prepared with meat tenderizer
• Pickled herring
• Potentially spoiled meat, poultry, or fish
• Salted, dried fish, such as herring, cod, or camlin
• Shrimp paste*

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)*
• Figs (overripe)
• Miso soup
• Red plums
• Sauerkraut*
• Soybean products*
• 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*
• Protein extracts
• Soups containing items that must be avoided*
• Soy sauce*
• 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.