What Are Low Tyramine Diets All About?
What Is Tyramine?
Tyramine is a breakdown product of the amino acid tyrosine. Bacteria or yeasts when left in food for long periods start to change tyrosine to tyramine and CO2. Fresh foods are generally low in tyramine. The amount of tyramine in the food increases with time. Tyramine builds up in food when we cure meats, age cheeses, pickle
foods, or brew beer, wine or cider. Tyramine also appears when food sits too long in the fridge or fruits get over ripe and start to spoil.
Tyrosine, the amino acid from which tyramine is made, is essential to the body, it is used to make hormones like dopamine and adrenaline. It’s also found in almost all foods but it is more abundant in high protein foods like milk, meat, legumes.
Why Can It be a Problem?
For most of us tyramine is nothing to worry about. Our bodies in their infinite wisdom have provided us with a special enzyme system in our gut to deal with any tyramine we eat. It has the melodious name of Cytochrome P450 and changes any tyramine it finds into a harmless compound. Most of us can eat as much tyramine in our food as we want and never experience any problems.
Two groups of people are not so lucky. They need to eat a low tyramine diet or they can get high blood pressure or migraine headaches. It’s
only for these few people that a low tyramine diet has been developed.
The first group is people taking medications that block
the tyramine enzymes. This makes them unable to deactivate tyramine, which then enters the blood. High levels of tyramine in the blood causes blood pressure to spike dangerously. When taking such medications people need to limit tyramine starting the day before and continuing for two weeks after they stop the medication to give their tyramine enzyme systems time to rebound.
Here are some of the medications that block the tyramine system:
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Selegiline (Emsam)
- Tranylcypromine (Parnate)
Some migraine suffers need to limit tyramine in their diet. This is only true for a few of the people who suffer migraines, those shown to be sensitive to tyramine. Interestingly when some of these tyramine sensitive people were tested they had abnormally low levels of the tyramine enzyme. The test for tyramine sensitivity involves keeping a food diary and seeing if migraines tend to trigger after high tyramine foods are eaten.
What Don’t We Know about Tyramine?
Tyramine is not well studied in food and so the list of safe / not safe foods keeps changing.
For a long time bananas were seen as high in tyramine but closer examination showed this high level was only in the peel—most of us do not eat the banana peel!
What’s still not clear is if the banana peels that were tested had turned brown and started to rot. The ripening process could also explain why avocados only sometimes test high in tyramine. Their flesh
can turn rather brown and taste spoiled. I suspect any overly ripe fruit or vegetable could be high in tyramine.
The amount of tyramine in a food is not constant. Different conditions can cause the food to age or spoil in ways that produce either a little or a large amount of tyramine. We can’t test every item we eat so we have to assume that the levels are high in all foods just to be safe.
Furthermore even when a food has high levels, the tyramine is not evenly distributed throughout the food. As an example, a wheel
of aged cheese was tested; samples taken from near the rind or near cheese holes had much higher levels of tyramine than other samples taken deep in the cheese and far from any air.
in the level of tyramine means that it’s not safe to trust negative results. It might be that a particular food item had less tyramine than expected. If you’re keeping a migraine diary, eating cheese might be fine once but not the next time. This may not mean you aren’t sensitive, just that on one occasion you got cheese that was low in tyramine.
What Foods Contain Tyramine?
Here’s a detailed list of foods high in tyramine developed by a dietitian. It includes the amount of tyramine in a food when there was actual data.
Cured meats, cheese and fish need to be avoided on this diet. Anything that’s
smoked or cured. Fresh meats that are canned or frozen are fine as are cheeses that are made and served fresh like cottage cheese or even mozzarella.
Bread products are OK on this diet as the yeast does not have time to develop a lot of tyramine in the bread dough before it’s
baked and the yeast killed. Breads like sourdough or artisan breads that sit with yeast for a long time are riskier.
Seasonings that use a yeast base like soy sauce, miso or marmite can be high in tyramine.
Vegetables and fruit are fine unless pickled like sauerkraut or kim chee. Tofu is of concern though soy milk is fine.
Alcohol is only tyramine free if it’s
Do You Need to Worry about Tyramine?
Unless you suffer from migraines or are on a medication that’s
on an MAOI medication, yes you need to stick to this diet or risk serious health consequences.
If you suffer migraines don’t just assume you’re sensitive to tyramine—keep a diary. Use it to see what you ate before a migraine developed. Were there foods from the high tyramine list? Just don’t expect foods from the high tyramine list to always trigger a migraine because sometimes they won’t have the expected amount of tyramine
This diet is easier to remember if you think that low tyramine foods are fresh. They can also be frozen or canned. Foods that are over ripe, meats, cheeses, vegetables, and condiments that have been aged can have high levels of tyramine and need to be avoided. If you do just that you’ll
have eliminated most of the problem foods. Good Luck!