Posted by SLS on June 2, 2001, at 17:07:13
In reply to MAOIs » Elizashae, posted by Elizabeth on June 1, 2001, at 0:33:46
Hi.
I checked out one of Shulman's more recent abstracts of those you so kindly listed (sincere - no sarcasm, just in case it sounded that way). I found in it a statement that I find dubious, and emphasised it by separating it from the surrounding text using asterisks.
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: J Clin Psychiatry 1999 Mar;60(3):191-3Comment in: J Clin Psychiatry. 2000 Feb;61(2):145-6
Refining the MAOI diet: tyramine content of pizzas and soy products.
Shulman KI, Walker SE.
Department of Psychiatry, University of Toronto, Sunnybrook Health Science
Centre, Ontario, Canada.BACKGROUND: Continuous refinement of the monoamine oxidase inhibitor
(MAOI) diet has resulted in much reduced and simplified recommendations
that attempt to balance safety and practicality. In the spirit of
evidence-based practice, dietary restrictions should be based on carefully
documented case reports and valid tyramine analyses. Residual concerns
have focused on combination foods such as pizza and a variety of soy
products. We determined the tyramine content of pizzas and a variety of
soy products in order to refine dietary recommendations for use with
MAOIs. METHOD: High-pressure liquid chromatography analysis of tyramine
content was performed on a variety of pizzas, soy sauces, and other
soybean products. A tyramine level of 6 mg or less was considered safe.
RESULTS: No significant tyramine levels were found in any of the pizzas,
*** including those with double pepperoni ***and double cheese. Marked
variability was found in soy products, including clinically significant
tyramine levels in tofu when stored for a week and high tyramine content
in one of the soy sauces. CONCLUSION: Pizzas from large chain commercial
outlets are safe for consumption with MAOIs. However, caution must be
exercised if ordering pizzas from smaller outlets or gourmet pizzas known
to contain aged cheeses. All soybean products should be avoided,
especially soy sauce and tofu. Individualized counseling and continuous
surveillance of compliance are still essential.PMID: 10192596 [PubMed - indexed for MEDLINE]
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Here is a good example of how elusive this whole MAOI diet thing is. I suffered a robust MAOI-food reaction when I accidentally ate one and one-half (1½) thin slices of pepperoni at the end of a slice of pizza. I was taking Parnate 60mg combined with desipramine 125mg at the time. I had been eating pizza from this same shop for at least six months while on this drug combination. Previously, I had always made sure that any pizza with toppings not include pepperoni or sausage. I consumed this pepperoni with an empty stomach. Within five minutes I suffered a severe headache that manifest as a pounding in the back of my head at the base of my skull (occipital). This pounding was more pronounced while sitting than while standing. I was at work on a busy Saturday and was reluctant to ask someone to drive me to the hospital or call an ambulance. I decided to ride it out. Probably stupid, but I needed the job. I had to remain standing for about 45 minutes before it dissipated. It was the real thing. My doctor explained very explicitly what it would feel like. I had never had such a headache previously nor have I had one since. I continued to eat pizza from this shop.I used the term "MAOI-food reaction" because it might not have been dependent exclusively upon tyramine. I have vague recollections that there are other mechanisms by which foodstuffs can precipitate a reaction other than through the ingestion of tyramine. My advice to anyone considering ordering a pepperoni pizza for personal consumption is to remove the pepperoni before eating it. :-) I also stay away from pastrami and corned-beef.
I eat cheese pizza or pizza topped with vegetables all of the time while taking MAOIs. I have also eaten sausage on occasion without having a reaction. Cheap processed American, mozzarella and ricotta cheeses are fine, but I would be careful with Parmesan, a cheese sometimes added to the pizza sauce. I pretty much roll the dice with that one. I stay away from "gourmet" and expensive imported cheeses. I am suspicious of those that I find hanging from the window curing.
I don't think measuring the tyramine content of food with the methods currently in use is sufficient to predict the potential for a food to elicit the "cheese reaction".
- Scott
poster:SLS
thread:64764
URL: http://www.dr-bob.org/babble/20010530/msgs/65197.html