What Is Tyramine and Why Does It Matter?
Tyramine is a naturally occurring substance that forms from the breakdown of the amino acid tyrosine, a process influenced by aging, fermentation, and microbial action in foods. For most people, the body's natural enzymes, particularly monoamine oxidase (MAO), effectively metabolize and break down excess tyramine without issues.
However, for individuals on MAOI medications, which are sometimes prescribed for conditions like depression and Parkinson's disease, this metabolic pathway is inhibited. This can lead to a buildup of tyramine in the body, which, in high concentrations, can trigger a hypertensive crisis—a potentially fatal condition involving a sudden and severe increase in blood pressure. Some individuals also experience tyramine intolerance, which can cause migraines and headaches. For these populations, managing dietary tyramine intake is critical for their health and safety.
The Low Tyramine Food List
Following a low tyramine diet means focusing on the freshest ingredients and avoiding foods known to be aged, fermented, cured, or improperly stored. The key principle is to eat foods that have been processed and stored as minimally as possible.
Meats, Poultry, and Fish
- Allowed: Fresh or frozen meat, poultry, and fish are safe when cooked and eaten promptly. This includes beef, pork, lamb, chicken, and fresh salmon or tuna. Canned fish like tuna or salmon is also acceptable, but should be consumed immediately after opening.
- To Limit/Avoid: Aged, smoked, or pickled meats, like hard salami, mortadella, and pepperoni, are high in tyramine and should be avoided. This also includes aged chicken liver, jerky, and cured or salt-dried fish.
Dairy Products
- Allowed: Many fresh dairy products are low in tyramine. Safe options include fresh milk, cottage cheese, cream cheese, ricotta cheese, mozzarella, and processed cheese slices.
- To Limit/Avoid: Aged, strong, and fermented cheeses are the most significant source of tyramine in many diets. Strictly avoid varieties like cheddar, blue cheese, camembert, gouda, feta, muenster, parmesan, and provolone. Yogurt, buttermilk, and sour cream should be limited to small amounts.
Fruits and Vegetables
- Allowed: Most fresh, frozen, or canned fruits and vegetables are low in tyramine and safe to consume. This includes apples, peaches, carrots, potatoes, asparagus, string beans, and leafy greens. Raisins are also permitted.
- To Limit/Avoid: Certain produce and overly ripe fruit can be high in tyramine. Avoid sauerkraut, kimchi, fava beans (broad beans), and snow peas. Overripe fruits such as bananas (especially the peel), figs, red plums, and avocados should be consumed with caution or avoided entirely.
Grains and Baked Goods
- Allowed: Most breads and grains are safe, including pasta, rice, dry cereals, and commercially prepared bread made with fresh baker's yeast.
- To Limit/Avoid: Sourdough bread and breads containing restricted ingredients, like aged cheese, should be limited or avoided. Concentrated yeast extracts like Marmite or Vegemite are very high in tyramine.
Beverages
- Allowed: Acceptable beverages include fresh fruit juices, milk, decaffeinated coffee and tea, and non-caffeinated sodas. Certain distilled liquors like bourbon, rum, vodka, and gin are also considered low in tyramine.
- To Limit/Avoid: Fermented and aged alcoholic beverages pose a risk. Avoid tap beer, home-brewed beer, and certain wines, particularly red wine and vermouth. Also, limit regular coffee, tea, and other caffeinated beverages.
Fats, Condiments, and Sauces
- Allowed: Most cooking oils and fats, white vinegar, and commercial salad dressings without restricted ingredients are safe. Ketchup, mustard, and Worcestershire sauce are generally considered low-tyramine.
- To Limit/Avoid: Avoid soy sauce, teriyaki sauce, fermented fish sauce, shrimp paste, and bouillon cubes or extracts.
Practical Tips for Managing a Low Tyramine Diet
Following a low tyramine diet involves more than just knowing which foods to eat and which to avoid; proper food handling and storage are equally important. Tyramine levels naturally increase over time, even in refrigerated foods.
- Emphasize Freshness: Buy fresh meats, poultry, and fish and use them immediately or freeze them right away. Consume fresh produce within 48 hours of purchase.
- Store Properly: Never thaw foods at room temperature. Use the refrigerator or microwave to thaw frozen items. Ensure all protein-rich foods are properly refrigerated to prevent spoilage.
- Handle Leftovers with Care: Eat leftovers within 24 to 48 hours, or freeze them promptly. The longer food sits, the more tyramine can form.
- Be Cautious When Dining Out: When eating at restaurants, you have less control over the freshness and storage of ingredients. Choose simply prepared dishes and ask questions about how foods were stored and prepared.
- Read Labels: Scrutinize ingredient lists for hidden tyramine sources like yeast extracts, bouillon, and fermented ingredients.
Low vs. High Tyramine Foods
| Food Category | Low Tyramine Examples | High Tyramine Examples |
|---|---|---|
| Protein | Freshly cooked chicken, beef, or fish; fresh eggs | Aged meats like salami and pepperoni; smoked or pickled fish; aged liver |
| Dairy | Fresh milk; cottage cheese; cream cheese; fresh mozzarella | Aged cheeses like cheddar, blue cheese, and parmesan; unpasteurized dairy |
| Produce | Most fresh fruits and vegetables; raisins | Sauerkraut; kimchi; fava beans; overly ripe bananas or avocados |
| Grains | Pasta; rice; dry cereals; commercially prepared bread | Sourdough bread; breads with aged cheese |
| Beverages | Water; decaf coffee; fresh fruit juice; gin; vodka | Tap or home-brewed beer; red wine; vermouth; aged wine |
| Condiments | Ketchup; white vinegar; most commercial dressings | Soy sauce; teriyaki sauce; meat extracts; yeast extracts like Marmite |
Conclusion
For individuals on MAOIs or those susceptible to migraines, adhering to a diet rich in low tyramine foods is essential for preventing potentially severe adverse health effects. The core of this diet lies in prioritizing freshness and proper food storage over aged, fermented, or processed products. While this may require significant adjustments to common dietary habits, following these guidelines, with careful attention to food selection and preparation, ensures that individuals can manage their condition effectively and safely. Always consult with a healthcare professional or a registered dietitian before making major dietary changes, especially when taking medication, to ensure proper nutrition and safety. For further information, visit the National Institutes of Health.
