The Connection Between Phenelzine, Tyramine, and Your Diet
Phenelzine, often sold under the brand name Nardil, is a type of antidepressant known as a monoamine oxidase inhibitor (MAOI). The purpose of MAOIs is to inhibit the monoamine oxidase enzyme, which helps break down certain neurotransmitters in the body. A critical side effect of this inhibition is that the body can no longer properly break down tyramine, an amino acid found naturally in some foods.
When a person taking phenelzine consumes too much tyramine, the substance accumulates in the body and causes a dangerous increase in blood pressure. This sudden and severe rise in blood pressure is a medical emergency known as a hypertensive crisis. To prevent this life-threatening reaction, a strict, low-tyramine diet is a mandatory part of treatment with phenelzine.
Can I Eat Cream Cheese While Taking Phenelzine?
Yes, you can typically eat cream cheese while taking phenelzine. This is because cream cheese is a fresh, unfermented dairy product with a very low tyramine content. Unlike aged or fermented cheeses, which have higher levels of tyramine due to the aging process, cream cheese is made from pasteurized milk and cream and is meant to be consumed fresh.
However, there are important rules to follow even with safe dairy products:
- Freshness is key: Always ensure your cream cheese is fresh and properly stored in the refrigerator. Spoilage can increase tyramine levels.
- Moderation is recommended: While safe, it's wise to consume it in moderate amounts.
- Avoid combined products: Be cautious of dishes like casseroles or cheese sauces that mix cream cheese with other, high-tyramine ingredients.
High-Tyramine Foods to Strictly Avoid
To manage your diet while on phenelzine, you must be aware of and completely avoid foods with high levels of tyramine. The risks associated with these foods are serious, and your healthcare provider will give you a detailed list of restrictions. Key foods to avoid include:
- Aged and fermented cheeses: All hard and soft aged cheeses are off-limits, including cheddar, Swiss, blue cheese, mozzarella, and brie.
- Cured and aged meats: Salami, pepperoni, mortadella, sausage, cured hot dogs, and cured or smoked fish (like herring or lox) should not be eaten.
- Fermented vegetables: Sauerkraut and kimchi are high in tyramine.
- Soy products: Fermented soy products, such as soy sauce, miso soup, and some bean curds, are also restricted.
- Yeast extracts: Spreads like Marmite and Vegemite are high in tyramine.
- Alcoholic beverages: Draft beer, home-brewed beer, and certain wines, especially red wine, can be problematic. Some commercial alcohol may be tolerated in strict moderation, but it's safest to avoid.
- Certain fruits and pods: Overripe fruits and broad bean (fava bean) pods contain high tyramine levels.
Food Safety and Handling Guidelines
Proper food handling is paramount on an MAOI diet, as tyramine levels increase as food ages. Following these practices helps ensure your food remains low in tyramine:
- Eat fresh foods: Always opt for the freshest ingredients possible. Cooked or frozen foods should be eaten immediately after preparing or thawing.
- Manage leftovers carefully: Consume leftovers from cooked meals within 24 to 48 hours. When in doubt, it is safer to freeze leftovers or discard them.
- Refrigerate promptly: Always store protein-rich foods like meat, fish, and dairy in the refrigerator as soon as you get home from the store.
- Avoid spoiled foods: Never eat or cook with anything that seems spoiled, has an unusual smell, or is past its expiration date. Cooking does not reduce tyramine levels.
- Be cautious when dining out: You cannot be certain how ingredients were stored or prepared in a restaurant, so stick to fresh, simply prepared items.
Comparison Table: Safe vs. High-Risk Foods
To simplify dietary choices while taking phenelzine, here is a comparison of typical safe foods versus those to avoid. This table serves as a guide but should always be discussed with your healthcare provider.
| Food Category | Safe (Low-Tyramine) Choices | Avoid (High-Tyramine) Choices |
|---|---|---|
| Dairy | Cream cheese, cottage cheese, ricotta, fresh pasteurized milk, fresh yogurt | Aged cheeses (cheddar, brie, Swiss, blue cheese, etc.), cultured sour cream |
| Meat & Fish | Freshly cooked meat, poultry, and fish | Aged, cured, pickled, or smoked meats (salami, pepperoni), pickled herring |
| Fruits & Veggies | Most fresh, frozen, or canned fruits and vegetables (except those listed as high) | Broad bean (fava bean) pods, overripe avocados, overripe fruit |
| Grains | Bread, cereals, pasta, rice | Sourdough bread |
| Sauces | Tomato sauce, commercial dressings without cheese | Soy sauce, teriyaki sauce, yeast extracts (Marmite, Vegemite) |
| Beverages | Bottled or canned beer (in moderation), water, fruit juices, milk | Draft beer, home-brewed beer or wine, red wine, liqueurs |
Conclusion
While phenelzine requires a strict diet to prevent a hypertensive crisis, you can safely consume cream cheese as it is a low-tyramine dairy product. The key is to prioritize fresh, unaged, and unfermented foods, maintain diligent food safety practices, and completely avoid any food known to be high in tyramine. Since individual tolerance can vary and new food production methods can alter tyramine levels, maintaining an open line of communication with your doctor or a registered dietitian is the most important step for your safety. Always confirm that any new food or beverage is safe for you before consumption.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult with your healthcare provider or a registered dietitian before making any changes to your diet while on medication.
