Understanding Tyramine and Its Impact
Tyramine is a naturally occurring amino acid derived from the amino acid tyrosine, and it's found in various plants and animals. For most people, consuming foods containing tyramine is harmless because the body's enzyme monoamine oxidase (MAO) breaks it down. However, for individuals who take monoamine oxidase inhibitor (MAOI) medications—used to treat conditions like depression and Parkinson's disease—this enzyme is blocked. As a result, tyramine can build up to dangerously high levels, causing a sudden and severe increase in blood pressure known as a hypertensive crisis. Additionally, tyramine is a well-documented trigger for migraine headaches in some sensitive individuals. The tyramine content in food is heavily influenced by how it is processed, stored, and aged. Fermentation, curing, and aging are the primary culprits for increasing tyramine concentration.
Aged and Fermented Cheeses
Cheeses are one of the most prominent sources of tyramine, with levels increasing significantly the longer they are aged or fermented. This is often referred to as the “cheese effect” in medical literature. The bacterial cultures used in cheese production break down proteins, releasing tyramine. The stronger and older the cheese, the higher the tyramine content.
High-Tyramine Cheeses to Limit or Avoid
- Aged cheeses: Cheddar, blue cheeses (Gorgonzola, Stilton), Swiss, Parmesan, feta, provolone, and gruyère.
- Cheese-based products: Pizza or casseroles made with aged cheese, fondue, and cheese-flavored snacks.
Cured, Smoked, and Processed Meats
The curing and aging processes used to preserve meats and fish can significantly increase their tyramine levels. This applies to many deli meats and smoked or fermented sausages.
Meats and Fish High in Tyramine
- Cured and dried sausages: Salami, pepperoni, summer sausage, and mortadella.
- Processed and smoked meats: Hot dogs, bacon, corned beef, and smoked or pickled fish (like pickled herring or smoked salmon).
- Meat extracts and offal: Soups or gravies made from meat extracts and improperly stored organ meats like chicken liver.
Fermented Soy Products and Other Condiments
Fermentation is a major factor in tyramine formation for many non-meat items. Soy-based products and many common sauces are particularly high in this compound.
Condiments and Fermented Items with High Tyramine
- Fermented soy products: Soy sauce, miso soup, tempeh, and fermented tofu.
- Pickled and fermented vegetables: Sauerkraut, kimchi, and traditional pickles.
- Yeast extracts: Marmite and Vegemite.
- Other sauces: Fish sauce, shrimp paste, and teriyaki sauce.
Fruits and Vegetables to Watch
While most fresh fruits and vegetables are low in tyramine, levels can increase with over-ripening or in certain varieties. Improper storage can also lead to higher concentrations.
Fruits and Vegetables Higher in Tyramine
- Overripe fruits: Overripe bananas, avocados, and some berries can have increased tyramine.
- Specific beans: Fava beans (or broad beans) and their pods are known to contain tyramine.
- Dried fruits: Raisins, dates, and figs.
Beverages
The fermentation process in many alcoholic beverages contributes to their tyramine content, but proper pasteurization can help. Different types of alcohol contain varying amounts of tyramine.
High-Tyramine Beverages
- Fermented alcohol: Tap beer (especially unpasteurized or home-brewed), red wine, sherry, and vermouth.
- Caffeine: Coffee and tea contain low levels of tyramine and can also affect MAO.
A Comparison of High vs. Low Tyramine Foods
This table provides a quick reference for making dietary decisions related to tyramine content. For individuals sensitive to tyramine, choosing options from the lower-tyramine column is generally safer.
| Food Category | High-Tyramine Examples | Low-Tyramine Examples |
|---|---|---|
| Dairy | Aged cheddar, blue cheese, Swiss, feta | Pasteurized milk, cream cheese, cottage cheese, ricotta, processed American cheese |
| Meat & Protein | Salami, pepperoni, cured ham, smoked fish, chicken liver | Fresh meat, fresh poultry, fresh fish, most legumes (not fava beans), eggs |
| Fermented Goods | Soy sauce, miso, tempeh, sauerkraut, kimchi | Fresh vegetables, fresh fruits (not overripe), most condiments (ketchup, mustard) |
| Beverages | Tap beer, red wine, vermouth, sherry | Bottled or canned beer (in moderation), clear liquors (gin, vodka) |
| Fruits & Veggies | Overripe bananas, avocados, fava beans, dried fruits | Most fresh or frozen fruits and vegetables |
Final Considerations for a Tyramine-Conscious Diet
Being mindful of tyramine-rich foods is crucial for people on MAOIs and those with a history of tyramine-triggered migraines. For those on MAOIs, a severe reaction can be a medical emergency, so strict avoidance of high-tyramine foods is often necessary. The key is to prioritize fresh, properly stored foods and to be a diligent label reader, as many processed products contain hidden fermented or aged ingredients. Cooking does not reduce tyramine levels, so freshness is paramount. Always consult with a healthcare professional or dietitian before making significant changes to your diet, especially if you are on medication. More detailed guidance on a low-tyramine diet can be found through resources like the NCBI Bookshelf.
Conclusion
Identifying which foods are high in tyramine is essential for certain individuals to manage their health effectively. The common denominator for high tyramine content is the aging and fermentation process, which affects aged cheeses, cured meats, fermented soy products, and certain alcoholic beverages. By carefully selecting fresh alternatives and understanding the risks, individuals can safely manage their diet and minimize adverse effects, particularly the risk of hypertensive crises when taking MAOIs or triggering migraines.
