Diet & MAOIs: Foods to Avoid & Dietary Precautions While Taking MAOIs

What Is an MAOI Diet?

An MAOI diet contains little to no tyramine, which means you are avoiding foods that are high in tyramine. MAOI medications block the MAO enzyme produced by the body to break down tyramine which can result in a build-up of tyramine in the body.¹ Tyramine is found in foods stored for long periods or fermented, such as yogurt, aged cheese, and many more. Foods high in tyramine can cause tyramine levels in the body to reach a high level and can cause dangerous side effects such as a hypertensive crisis.

What Are MAOIs?

Monoamine oxidase inhibitors (MAOIs) medications are antidepressants prescribed as a treatment for depression. The medication was among the first medication for treating depression and was effective; however, its use has declined over time. This is due to the risk of side effects with the medication due to interactions with food and other medications and the introduction of better-tolerated drugs to treat depression.

How Do MAOIs Work?

MAOIs affect neurotransmitters, which are the chemical messengers in the brain. These include norepinephrine, serotonin, and dopamine. MAOI medications block the monoamine oxidase (MAO) enzyme, which removes the neurotransmitters from the brain, leaving higher amounts of the neurotransmitters. These neurotransmitters can help to treat depression.

MAOIs were one of the first medications approved for depression and were effective and are still sometimes used to treat cases of depression when the other treatment options have failed. MAOIs are FDA-approved as a treatment for depression and include the following medications:  isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate). Sometimes, the medication is used as an off-label treatment for Parkinson’s disease. An off-label use is not FDA-approved, but the medication may be used for the condition based on the professional judgment of the prescriber.

Why Are There Food Restrictions While Taking MAOIs?

MAOIs are widely known to interact with certain foods, so medical doctors often prescribe safer medication. In some cases, a doctor may prescribe this medication to you, and they may inform you about foods to avoid with MAOI medication. These foods are high in tyramine, a compound that may affect your blood pressure. MAOIs block the MAO enzyme that breaks down the tyramine in the body, leading to increased levels of tyramine in the body that can cause dangerous side effects such as a hypertensive crisis.²

To prevent these MAOI food interactions, a qualified healthcare provider may prescribe the medication and tell you to avoid certain foods while taking these medications.

What is Tyramine?

Tyramine is found in protein-rich foods such as fermented foods or foods stored for an extended period. For tyramine to be broken down in the body, an enzyme known as an MAO must be present. However, when a person takes MAOI medications, the MAO is blocked, which can cause a high level of tyramine in the blood vessels. High levels of tyramine in the blood may narrow blood vessels leading to high blood pressure or dangerous side effects such as a hypertensive crisis.

MAOI & Tyramine Interactions

MAOIs interact with foods that are high in tyramine and can have harmful outcomes. A prescriber or pharmacist may tell you which tyramine-rich foods to avoid while you take the medication. However, reading the ingredients in foods carefully is essential as you may unknowingly eat tyramine-rich food.³

Hypertensive Crisis

A hypertensive crisis can happen when the level of tyramine rises in the body and causes  the narrowing of blood vessels. This increases the blood pressure in the blood vessels and can cause dangerous side effects that may be fatal if left unattended. AnMAOI diet that is low in tyramine helps to reduce the risk of hypertensive crisis., MAOI medications have largely been replaced by newer antidepressants that have fewer interactions, but they may still be prescribed for certain people.

Symptoms of a high tyramine level may include:

• Severe headache
• Nausea
• Vomiting
• Sweating

Risk of Hypertensive Crisis

If the levels of tyramine are high in the blood vessels, there is an increased risk of suffering from a hypertensive crisis.

Symptoms of a hypertensive crisis may include:

• Symptoms of anxiety
• Blurred vision
• Chest pain (may be accompanied by shortness of breath)
• Severe headache
• Fainting
• Fast or irregular heart rate

Can You Eat a Small Amount of Food With Tyramine on an\ MAOI Diet?

You can eat a small amount of food with tyramine on an MAOI diet. People taking an MAOI medication may eat tyramine at low levels, between 10mg and 25mg.⁴ Tyramine level content increases as the food ages; therefore, to prevent aged or matured foods, for example, aged cheese.You should talk with your prescriber or your pharmacist about how much tyramine is safe for you to eat with an MAOI medication.

Following a Low-Tyramine Diet

Some foods that contain low or no levels of tyramine can be eaten while taking an MAOI medication.

Foods to avoid or that are safe to eat while taking an MAOI include:

Food Group	Foods That May Need to be Avoided	Foods That May Be Ok to Eat With an MAOI
Dairy products	Aged or matured dairy products: Hard cheese Processed cheese	Fresh and non-matured dairy products: Milk Cottage cheese
Meat & meat alternatives	Cured, aged, smoked, beef liver, chicken liver, fermented sausages (pepperoni and salami) bacon, hot dogs, corned beef, and luncheon meats. Soy-based meat alternatives.	Properly stored and fresh, or consume immediately after opening canned meat, poultry, or fish
Breads & Cereals	Fermented bread or bread with aged cheese	Plain bread or cereal
Fruits & Vegetables	Overripe or spoiled fruits	Fresh properly stored
Fats & Oils	N/A	N/A
Spreads & Sauces	Fish sauce Shrimp paste Concentrated yeast	All other sauces that don’t contain tyramine
Soups	Meat-based soups	Vegetable-based soups
Alcohol	Fermented wine Home-brewed beer with yeast	Bottled beer

The Importance of Food Safety While on an MAOI Diet

We have learned that in some foods, the level of tyramine increases as the food ages. These include cheese, fruits as they are overripe, and fermented products. High tyramine levels can also occur when food is stored for extended periods. Therefore, you should carefully check the labels of foods that you eat.

To reduce the risk of increasing tyramine levels, eat freshly cooked food within 48hrs of cooking and freeze fresh foods within 24 hours of purchase.⁵ Remember to consult a medical provider before changing your diet.

Here are some food safety precautions to take while on an MAOI diet:

• Always consume food immediately after being cooked or within 48 hours before tyramine levels start increasing.
• Avoid refreezing thawed food, which may have increased levels of tyramine.
• Practice proper food handling skills
• Cook food at the proper temperature.
• Eat the freshest food possible.
• Check the expiry date and do not consume food past the expiration date
• Store cold foods at the proper temperature
• Read labels of all food before eating

What Else Should You Avoid While on MAOIs?

MAOIs interact not only with foods but also with some medications that may cause a rise in blood pressure. Therefore, inform your doctor if you are taking MAOIs before you add any other medication, supplement, or herbs.⁵

Supplements and medications you should avoid while taking MAOIs include:

• St. John’s Wort
• Bupropion (Wellbutrin)
• Mirtazapine (Remeron)
• Sympathomimetic amines, e.g., amphetamine salts

This is not a comprehensive list of possible interactions with MAOIs. You should talk with your prescriber or pharmacist about your diet and any prescription or over-the-counter medications, herbs, or supplements you take before starting an MAOI.

Questions to Ask Your Health Team About an MAOI Diet

When your doctor prescribes MAOI medication, it is important to ask what foods to avoid and the precautions to take. If you need to speak to a medical provider for advice, online psychiatry services are available when you can schedule a call when you are free.

Questions to ask your care team about following an MAOI diet while taking antidepressants include:

• Is there a safe amount of tyramine that I can consume while taking antidepressants?
• If someone wants to eat a high-tyramine food, should they stop taking antidepressants for the day?
• What should I do if I eat a high-tyramine food anyway and have an adverse reaction?
• What is the interaction between tyramine and MAOIi?
• What foods do you avoid with MAOI medication?
• What is an MAOI food restriction?
• What foods should I avoid while taking MAOI medication?
• Is it necessary to eat a low-tyramine diet?

In My Experience

In my experience, MAOI medications are used to treat severe, resistant depression, unresponsive to other medication treatments and therapy. This therapeutic classification of medication has been replaced by safer antidepressants with fewer side effects. It is important to discuss with your medical provider the food you need to avoid reducing instances of a hypertensive crisis. For patients who have been prescribed this medication, if they have any questions, they should speak to a qualified person to avoid serious side effects.