For the full text, please download the PDF using the button on the right. There are over 40 pages, 200 citations and almost 20,000 words. A table of contents is shown below:

Table of Contents

• Abstract
• Introduction and background
• Some common myths
• How much tyramine produces a risk of serious hypertension?
• Introduction to dietary guide
• The symptoms of a hypertensive reaction
• Tyramine in foods and beverages
• General comments on diet and tyramine
• Tyramine pharmacokinetics
• Cheeses and dairy products
  • Processed cheese
  • Classic matured (hard, semi-hard) cheeses
  • Other cheeses (non-hard)
  • Non-matured cheeses, yogurt, milk
  • Milk and yogurt
• Fermented vegetables/cereals (Inc. sauces)
• Marmite, Bovril, Promite, Vegemite etc.
• Soya bean products
• Soy sauce, natto, miso and sufu etc.
• Fermented sauces: Animal
• Meat and fish products
  • Meat, fresh
  • Sausages, pâté, meat pastes
  • Preparations of stock cubes, powders, bouillon, etc.
  • Fish
  • Fish sauces
• Pizza
• Vegetables and fruits
• L-DOPA
• Pickling and preserving
• Health and sport supplements
• Other non-serious interactions
• Holidays
• Wine, spirits and beer
  • Wines
  • Beers
• MAOIs and scombroidosis (histamine fish poisoning)

Abstract

This comprehensive monograph surveys original data about dietary tyramine and Monoamine Oxidase Inhibitors (MAOIs), about which there is much outdated, incorrect, and incomplete information in the medical literature and elsewhere.  It has a comprehensive explanation of how tyramine builds up in different foods and beverages, as well as extensive information and references, about all foods.

Few foods now have problematically high tyramine levels, that is a result of changes in international food production methods and hygiene regulations.  Cheese was the only food that, in the past, has been associated with documented fatalities resulting from acute tyramine-induced hypertension.  Nowadays most cheeses are safe, and even ‘matured’ cheeses are usually safe in healthy-sized portions.  The variability of ‘pressor’ sensitivity to tyramine between individuals, and the unpredictable amount of tyramine content in a few foods, requires a little knowledge and care.

Many of the drug interactions previously supposed to be serious are either non-existent or non-serious.  The few interactions between MAOIs and other drugs are now well understood and are quite straightforward to avoid and deal with.  They are detailed in other commentaries.

The low degree of risk consequent upon a brief episode of acute hypertension, and the dangers of over-treating it with drugs such as nifedipine, are explained and discussed.

MAOIs have good efficacy in most forms of serious depressive illnesses, including melancholic and psychotic conditions, and are of comparable safety to most other currently used treatments, and straightforward to use, contrary to much current teaching.  Previously held concerns about MAOIs are, as White said in a report to the American College of Neuropsychopharmacology 40 years ago, mostly ‘mythical’ and misleading: either they are of over-rated importance, or incorrect, or no longer relevant.

Introduction and background

If a man is offered a fact which goes against his instincts, he will scrutinize it closely, and unless the evidence is overwhelming, he will refuse to believe it.  If, on the other hand, he is offered something which affords a reason for acting in accordance with his instincts, he will accept it even on the slenderest evidence.  The origin of myths is explained in this way.

Bertrand Russell, Proposed Roads to Freedom

This monograph is intended to update, inform, and assist both medical and non-medical readers — it is now supplemented by, not only the extensive commentaries already on the website, but also by several videos and podcasts

The one on tyramine is here  https://youtu.be/Wbo3GJ2DvkI

This monograph is lengthy, not because the subject is complex, but because exposing the myths surrounding MAOIs involves more than mere contradiction, and because I provide extensive references.  The subject of MAOIs is richly cloaked in myth: unfortunately, a mythical assertion often repeated is more firmly established in people’s minds than a truth stated but once.

Standard texts cover many issues within tight space constraints.  They contain abbreviated discussion and information, often by authors who are not expert in the subject; that causes confusion because such texts contradict the contents of in-depth analyses, such as this monograph.

There is now a lot of new quality data on tyramine in foods, and on how much tyramine is likely to constitute a potentially serious problem [1].  Previous opinions and advice have been based on old and sometimes inaccurate data, e.g. [2].

This monograph surveys more original data on tyramine than any paper previously published.  There are more than 200 new references, mostly recent, that have never been cited in the medical literature.

An abridged version of this monograph has (2019) been published as a peer-reviewed article in the Journal of Neural Transmission [3], but that does not have the full list of references — so this version may be preferred by those who wish to have full references and details.

Biogenic amines (BAs), including tyramine, are heat stable: they are not inactivated by cooking.  Furthermore, decarboxylating enzymes are also heat-tolerant and may survive some cooking methods, allowing continued accumulation of Bas, if cooked food is then poorly refrigerated.

Storage of foods below at <4°C is a crucial requirement, and some domestic fridges fail to maintain temperatures of below that.  An accurate thermometer must be used to check fridge temperatures.

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