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Dr. Bob is Robert Hsiung, MD,
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Posted by gardenergirl on November 19, 2004, at 16:37:53
In reply to more MAOI diet questions, posted by KaraS on November 19, 2004, at 16:08:12
Kara,
I hand the wait staff a printed card with my restrictions on it and ask the waiter to check with the cook about what I ordered. I have not had a problem with this, except for one manager who kept insisting their sauces were homemade...duh, dude, that's fine...but do they contain any of these ingredients?Anyway, unless they are lying to me, I've not had a problem. I admit, though, I choose wisely from the get-go. I don't ask them to check on the Alfredo sauce, cause I know there's parmesan in it. So it's mostly me deciding what looks safest and then checking my decision out. Sometimes, to be safe, they modify something for me by skipping the sauce or something.
I suppose it depends on the restaurant, though?
gg
Posted by King Vultan on November 19, 2004, at 17:11:01
In reply to more MAOI diet questions, posted by KaraS on November 19, 2004, at 16:08:12
> I'm still a bit confused about the diet. I know that yeast extract and soy preparations can be very dangerous to take while on an MAOI. I still don't understand how you can know about the contents of food when you go out to eat. There are so many sauces and prepared foods used by restaurants these days that contain yeast extract, soy protein isolate, teriaki sauce, some grated parmesan cheese used as a spice etc. Even if you ask the wait people, chances are you're not going to find out that these are in the food as the cooks themselves probably don't even know it. I know that this hasn't been a big problem for people here who take MAOIs but I don't understand why not. If anyone can shed some light on this for me, I'd really appreciate it.
>
> Thanks,
> Kara
Grated parmesan cheese does not have a huge amount of tyramine in it. If it is just being used as a spice, I would not worry about it. The yeast extract that is problematic is Marmite, which I honestly know nothing about other than it is apparently available at some health food stores. Other yeast extracts, such as brewer's yeast, do not have significant amounts of tyramine. Soy products can contain significant amounts of tyramine, but the most important one does seem to be soy sauce; although, there is definitely a wide variability between different brands, and there may be some lot to lot differences, as well. I guess if I were ordering something I was not familiar with, I would just ask if it had any soy sauce in it. I have bought some prepared foods myself with levels of soy sauce low enough so that, in my judgement, they were highly unlikely to prove problematic, and I did not experience any problems. I am also currently using some low fat peanut butter that is augmented with some kind of soy protein and have not noticed anything (I actually bought it by mistake but am too thrifty to throw away food unless it is old or unedible). OTOH, I was looking at a new low carb cereal that had soy grits and perhaps concentrated soy protein as major ingredients, and I was simply not comfortable enough to buy it. In general, though, I will say that carrying nifedipine does tend to act as a psychological safety blanket and negate a lot of needless worrying, but I think if a person takes reasonable care, there should be no reason to ever have to use it. Some MAOI patients even eat the prohibited foods indiscriminately and get away with it in many cases, but I do believe this is extraordinarily unwise.Todd
Posted by cosis on November 19, 2004, at 17:22:57
In reply to Re: more MAOI diet questions » KaraS, posted by gardenergirl on November 19, 2004, at 16:37:53
> Kara,
> I hand the wait staff a printed card with my restrictions on it and ask the waiter to check with the cook about what I ordered. I have not had a problem with this, except for one manager who kept insisting their sauces were homemade...duh, dude, that's fine...but do they contain any of these ingredients?
>
> Anyway, unless they are lying to me, I've not had a problem. I admit, though, I choose wisely from the get-go. I don't ask them to check on the Alfredo sauce, cause I know there's parmesan in it. So it's mostly me deciding what looks safest and then checking my decision out. Sometimes, to be safe, they modify something for me by skipping the sauce or something.
>
> I suppose it depends on the restaurant, though?
>
> ggWow I wish I would do that... I have ate anything and everything over the last 3 years being on Nardil.
My doc actually said I was allowed to drink 1/3 of a beer and that was it? I was thinking in my head "buddy I downed about 12 beers last night"
Posted by Dan Perkins on November 19, 2004, at 18:08:29
In reply to Re: more MAOI diet questions, posted by cosis on November 19, 2004, at 17:22:57
I was on Parnate for a year and ate out 1-2 times/day every day, and I never had a problem. That includes beer, plenty of parmesan cheese on different kinds of pizza and in Alfredo sauce, and plenty of sauces at restaraunts. I was not overly cautious and I never had a problem.
I think the key is to be aware of the few foods with sky-high tyramine content (yeast extracts, fermented soy products, etc.) and not sweat the rest too much.
I think the dietary restrictions for MAOIs are overblown and should never be an excuse not to try the drugs.
Posted by sfy on November 19, 2004, at 19:51:37
In reply to Re: more MAOI diet questions, posted by Dan Perkins on November 19, 2004, at 18:08:29
For starters you can look here:
http://www.dr-bob.org/tips/maoi.html
Some of this advice is admittedly contradictory and sometimes anecdotal. But that's part of the problem with MAOI's - there's variation in both the tyramine content of similar foods and how people react when on MAOI's. What would cause no problem for one person will result in a hypertensive crisis for another.
In the two plus years I was on Nardil, I had no problems but I was pretty strict about the diet. However, now that I'm contemplating (and procrastinating about) going on Parnate, I'm a bit more wary since due to all the noise out there about the diet. Plus my lifestyle has changed somewhat putting me more at risk of ingesting something that might cause problems (particularly alcohol).
But if you do go the MAOI route, your pdoc should prescribe a supply of nifedipine to carry just in case. If he/she doesn't then he has no business prescribing MAOI's.
Posted by King Vultan on November 19, 2004, at 20:01:09
In reply to Re: more MAOI diet questions, posted by cosis on November 19, 2004, at 17:22:57
>
> Wow I wish I would do that... I have ate anything and everything over the last 3 years being on Nardil.
>
> My doc actually said I was allowed to drink 1/3 of a beer and that was it? I was thinking in my head "buddy I downed about 12 beers last night"
The recommendation by Dr. Shulman, who has done a lot of research on the MAOI diet, is no more than two bottled or canned beers per day. However, I believe this is based more off Parnate than Nardil because Parnate is significantly more powerful at potentiating the hypertensive effect. My own opinion is that a six pack could be consumed with impunity by someone on Nardil, probably even a 12 pack, as long as one was not also consuming significant amounts of other tyramine containing foods.The point Dr. Shulman makes, however, is that MAOI patients should stick to bottled or canned beer (the equivalent level of wine is also okay) and avoid tap beer. The reason he brings this up is that one of the patients at their facility, who was on 60 mg Nardil, suffered a hypertensive crisis after consuming approximately 14 oz. of tap beer, which certainly does not seem like an imprudent amount. Subsequently, an "analysis of 79 tap and bottled beers revealed 4 tap samples to have alarmingly high tyramine contents." Obviously, not every bar is going to have a problem, but I agree that it's best for MAOI patients to stick with bottles or cans.
Todd
Posted by KaraS on November 19, 2004, at 20:07:16
In reply to more MAOI diet questions, posted by KaraS on November 19, 2004, at 16:08:12
Posted by Dan Perkins on November 20, 2004, at 0:49:32
In reply to Re: more MAOI diet questions, posted by sfy on November 19, 2004, at 19:51:37
Not so sure the nifedipine is a good idea. I was prescribed it by my pdoc but the preponderance of research and anecdotal information that I have come across show that you are better off not taking it in the event of a hypertensive crisis.
>But if you do go the MAOI route, your pdoc should prescribe a supply of nifedipine to carry just in case. If he/she doesn't then he has no business prescribing MAOI's.
Posted by KaraS on November 20, 2004, at 3:11:20
In reply to Re: more MAOI diet questions, posted by Dan Perkins on November 20, 2004, at 0:49:32
Once I commit to starting the Parnate I will be very careful diet-wise. If it means consuming only bottled beer and a small amount of it, then I'm more than willing to pay that price for my mental health. I have no problem giving up any of the other foods on the list either. I just want to be sure that I can identify them in foods prepared by someone else.
Also, re: nifedipine, I hadn't heard any controversy about it's use for hypertensive crises. Has anyone of you ever taken it before? If so, how did it work? I read that reboxetine is actually good for countering this problem but I don't know if it's good after-the-fact or just prophylactically.
Posted by King Vultan on November 20, 2004, at 11:01:15
In reply to Re: more MAOI diet questions, posted by KaraS on November 20, 2004, at 3:11:20
>
> Also, re: nifedipine, I hadn't heard any controversy about it's use for hypertensive crises. Has anyone of you ever taken it before? If so, how did it work? I read that reboxetine is actually good for countering this problem but I don't know if it's good after-the-fact or just prophylactically.
Yes, there are different schools of thought on nifedipine and MAOIs. My GP does not think it's a very good idea, and I know that one of this specialities is blood pressure meds, and he probably does have legitimate reason for concern. My pdoc--from whom I got the prescription--seems to be less concerned, but he said that ideally, the prudent thing to do is to visit a hospital emergency room if a hypertensive crisis occurs. The problem with that is the anecdotes I've read from people who have done this and suffered horribly because the people at the hospital were ignorant and/or did not take their symptoms seriously, and the patients did not receive proper (or any) treatment.The authors (Perry and Lund) of a paper on MAOI adverse effects I have posted links to in the past also wind up discouraging the use of nifedipine. This is inspite of the fact that they state that "In all 29 cases of hypertensive crisis, the nifedipine was rapidly effective and no ADRs (adverse reactions) were noted even when the nifedipine was taken for the wrong reasons. No patient noted a rapid remission of the headache unless and until the nifedipine was taken." It should be noted that they seem to be referring to nifedipine taken sublingually (under the tongue); I have read other views elsewhere that the nifedipine pill should be crushed between the teeth and swallowed. I guess it's the latter method I would tend to use myself if I were in a situation where I was forced to use the nifedipine. However, I am not expecting to have to actually use it, given that I seem to be relatively careful and conscientious about the dietary and drug restrictions.
Todd
Posted by Iansf on November 20, 2004, at 13:25:56
In reply to Re: nifedipine » KaraS, posted by King Vultan on November 20, 2004, at 11:01:15
> Yes, there are different schools of thought on nifedipine and MAOIs. My GP does not think it's a very good idea, and I know that one of this specialities is blood pressure meds, and he probably does have legitimate reason for concern. My pdoc--from whom I got the prescription--seems to be less concerned, but he said that ideally, the prudent thing to do is to visit a hospital emergency room if a hypertensive crisis occurs. The problem with that is the anecdotes I've read from people who have done this and suffered horribly because the people at the hospital were ignorant and/or did not take their symptoms seriously, and the patients did not receive proper (or any) treatment.
>My experience at the emergency rooms was certainly unpleasant. I was made to feel as if I was wasting their time.
Posted by KaraS on November 20, 2004, at 13:51:38
In reply to Re: nifedipine » KaraS, posted by King Vultan on November 20, 2004, at 11:01:15
>
> >
> > Also, re: nifedipine, I hadn't heard any controversy about it's use for hypertensive crises. Has anyone of you ever taken it before? If so, how did it work? I read that reboxetine is actually good for countering this problem but I don't know if it's good after-the-fact or just prophylactically.
>
>
> Yes, there are different schools of thought on nifedipine and MAOIs. My GP does not think it's a very good idea, and I know that one of this specialities is blood pressure meds, and he probably does have legitimate reason for concern. My pdoc--from whom I got the prescription--seems to be less concerned, but he said that ideally, the prudent thing to do is to visit a hospital emergency room if a hypertensive crisis occurs. The problem with that is the anecdotes I've read from people who have done this and suffered horribly because the people at the hospital were ignorant and/or did not take their symptoms seriously, and the patients did not receive proper (or any) treatment.
>
> The authors (Perry and Lund) of a paper on MAOI adverse effects I have posted links to in the past also wind up discouraging the use of nifedipine. This is inspite of the fact that they state that "In all 29 cases of hypertensive crisis, the nifedipine was rapidly effective and no ADRs (adverse reactions) were noted even when the nifedipine was taken for the wrong reasons. No patient noted a rapid remission of the headache unless and until the nifedipine was taken." It should be noted that they seem to be referring to nifedipine taken sublingually (under the tongue); I have read other views elsewhere that the nifedipine pill should be crushed between the teeth and swallowed. I guess it's the latter method I would tend to use myself if I were in a situation where I was forced to use the nifedipine. However, I am not expecting to have to actually use it, given that I seem to be relatively careful and conscientious about the dietary and drug restrictions.
>
> Todd
So, do you carry it just in case or not? I wonder why they don't recommend taking it given all the positive things you said about it.
Posted by KaraS on November 20, 2004, at 13:55:16
In reply to Re: nifedipine » King Vultan, posted by Iansf on November 20, 2004, at 13:25:56
> > Yes, there are different schools of thought on nifedipine and MAOIs. My GP does not think it's a very good idea, and I know that one of this specialities is blood pressure meds, and he probably does have legitimate reason for concern. My pdoc--from whom I got the prescription--seems to be less concerned, but he said that ideally, the prudent thing to do is to visit a hospital emergency room if a hypertensive crisis occurs. The problem with that is the anecdotes I've read from people who have done this and suffered horribly because the people at the hospital were ignorant and/or did not take their symptoms seriously, and the patients did not receive proper (or any) treatment.
> >
>
> My experience at the emergency rooms was certainly unpleasant. I was made to feel as if I was wasting their time.How awful for you. It's not bad enough we have to deal with all of the ignorance around depression itself, but then to have to deal with the ignorance about this kind of immediate serious medical condition is unimaginable. What food did you eat that created the experience to begin with?
Posted by Iansf on November 20, 2004, at 19:13:12
In reply to Re: nifedipine » Iansf, posted by KaraS on November 20, 2004, at 13:55:16
> >
> > My experience at the emergency rooms was certainly unpleasant. I was made to feel as if I was wasting their time.
>
> How awful for you. It's not bad enough we have to deal with all of the ignorance around depression itself, but then to have to deal with the ignorance about this kind of immediate serious medical condition is unimaginable. What food did you eat that created the experience to begin with?
>
>
As far as I know, none. I couldn't trace the crisis to any food or drug. Of course, it's possible there was some ingredient I didn't know about in something I ate. It would be rare for a tiny amount of something to cause a crisis, yet if there were a large amount you'd think the taste would make its presence evident.
Posted by SLS on November 20, 2004, at 19:34:26
In reply to Re: nifedipine » KaraS, posted by Iansf on November 20, 2004, at 19:13:12
Hi.
> As far as I know, none. I couldn't trace the crisis to any food or drug. Of course, it's possible there was some ingredient I didn't know about in something I ate. It would be rare for a tiny amount of something to cause a crisis,
The amount of tyramine that can cause a hypertensive event can be measured in milligrams. It doesn't take much. My only hypertensive reaction came from taking a single bite out of a pepperoni pizza. I ingested probably 1 1/2 pieces of thinly sliced pepperoni. The headache was pretty classic - pounding and eminating from the base of the skull in the back (occipital). I was taking Parnate 60mg at the time. I believe that it was the pepperoni because the plain pizzas coming from the same restaurant had not given me any problems. The appearance of the "cheese" reaction is rather unpredictable. That's why it should be respected.
- Scott
Posted by gardenergirl on November 20, 2004, at 21:48:59
In reply to Re: nifedipine, posted by SLS on November 20, 2004, at 19:34:26
Turkey giblets in the gravy and dressing
gg
Posted by King Vultan on November 21, 2004, at 10:13:19
In reply to Re: nifedipine » King Vultan, posted by KaraS on November 20, 2004, at 13:51:38
>
>
> So, do you carry it just in case or not? I wonder why they don't recommend taking it given all the positive things you said about it.
>
>Yes, I do carry it (2 x 10 mg). Since I also carry Parnate with me so that I can take it throughout the day, it is no additional inconvenience to carry the nifedipine.
Todd
Posted by KaraS on November 21, 2004, at 15:54:25
In reply to Re: nifedipine » KaraS, posted by Iansf on November 20, 2004, at 19:13:12
> > >
> > > My experience at the emergency rooms was certainly unpleasant. I was made to feel as if I was wasting their time.
> >
> > How awful for you. It's not bad enough we have to deal with all of the ignorance around depression itself, but then to have to deal with the ignorance about this kind of immediate serious medical condition is unimaginable. What food did you eat that created the experience to begin with?
> >
> >
> As far as I know, none. I couldn't trace the crisis to any food or drug. Of course, it's possible there was some ingredient I didn't know about in something I ate. It would be rare for a tiny amount of something to cause a crisis, yet if there were a large amount you'd think the taste would make its presence evident.Maybe you had one of those spontaneous hypertensive crises. How frightening. How long were you on it before that happened? I'm assuming you went off of the medication at that point?
Posted by KaraS on November 21, 2004, at 15:58:01
In reply to Re: nifedipine, posted by SLS on November 20, 2004, at 19:34:26
> Hi.
>
> > As far as I know, none. I couldn't trace the crisis to any food or drug. Of course, it's possible there was some ingredient I didn't know about in something I ate. It would be rare for a tiny amount of something to cause a crisis,
>
> The amount of tyramine that can cause a hypertensive event can be measured in milligrams. It doesn't take much. My only hypertensive reaction came from taking a single bite out of a pepperoni pizza. I ingested probably 1 1/2 pieces of thinly sliced pepperoni. The headache was pretty classic - pounding and eminating from the base of the skull in the back (occipital). I was taking Parnate 60mg at the time. I believe that it was the pepperoni because the plain pizzas coming from the same restaurant had not given me any problems. The appearance of the "cheese" reaction is rather unpredictable. That's why it should be respected.
>
>
> - Scott
That's amazing. What does one do when the problem occurs? How long does it last? Did you take something or ride it out? Did you go to an emergency room?
Posted by KaraS on November 21, 2004, at 16:01:29
In reply to Re: nifedipine, posted by gardenergirl on November 20, 2004, at 21:48:59
> Turkey giblets in the gravy and dressing
>
> gg
Hi gg,I'll ask you the same questions I asked Scott:
Was that the only crises you've had? what did you do about it? Did you take nifedipine? Did you go to an emergency room? How long did it last? It must not have been that awful as you still continued on the medication.K
Posted by KaraS on November 21, 2004, at 16:04:30
In reply to Re: nifedipine » KaraS, posted by King Vultan on November 21, 2004, at 10:13:19
>
> >
> >
> > So, do you carry it just in case or not? I wonder why they don't recommend taking it given all the positive things you said about it.
> >
> >
>
> Yes, I do carry it (2 x 10 mg). Since I also carry Parnate with me so that I can take it throughout the day, it is no additional inconvenience to carry the nifedipine.
>
> Todd
>
>
So you've obviously weighed the pros and cons of nifedipine and decided the pros have it. I shouldn't think it would be much of an inconvenience particularly if you think it would be helpful.Kara
Posted by KaraS on November 21, 2004, at 18:00:08
In reply to Re: nifedipine, posted by gardenergirl on November 20, 2004, at 21:48:59
> Turkey giblets in the gravy and dressing
>
> gg
Actually, now that I think about it, why should this cause a problem unless the giblets were aged?
Posted by gardenergirl on November 21, 2004, at 19:50:52
In reply to Re: nifedipine » gardenergirl, posted by KaraS on November 21, 2004, at 16:01:29
I think liver of any kind for some reason has more tyramine in it. But I could be wrong.
I got a terrible headache, but I attributed it at the time to some dental work I had done that week. I took a Vicoprofen that had been prescribed by the dentist, but it didn't help at all. I just rode it out. My cousin is a massage therapist, and she tried to help, but nothing did. I finally left early, and by the time I got home my BP was running about 129/75, which is a tiny bit high for me, but still normal.
I used to get migraines a lot, which actually have gone away with Nardil. So this wasn't any worse. I didn't realize it might have been a hypertensive crisis (or maybe just concern? ;) until a week or two later.
I've never had another one.
gg
Posted by KaraS on November 22, 2004, at 3:05:33
In reply to Re: nifedipine, posted by gardenergirl on November 21, 2004, at 19:50:52
> I think liver of any kind for some reason has more tyramine in it. But I could be wrong.
>
> I got a terrible headache, but I attributed it at the time to some dental work I had done that week. I took a Vicoprofen that had been prescribed by the dentist, but it didn't help at all. I just rode it out. My cousin is a massage therapist, and she tried to help, but nothing did. I finally left early, and by the time I got home my BP was running about 129/75, which is a tiny bit high for me, but still normal.
>
> I used to get migraines a lot, which actually have gone away with Nardil. So this wasn't any worse. I didn't realize it might have been a hypertensive crisis (or maybe just concern? ;) until a week or two later.
>
> I've never had another one.
> gg
Thanks, gg.I went out to dinner tonight and I looked at the menu as if I were on Parnate already. I thought I understood what was safe and what wasn't but then I looked at the menu and it was all a blur to me. I got very scared that I wouldn't be able to handle this. Were you overwhelmed at first too? Also, how much nifedipine do you carry with you? How much would you take if you were to experience a problem?
Kara
Posted by gardenergirl on November 22, 2004, at 8:08:19
In reply to Re: nifedipine » gardenergirl, posted by KaraS on November 22, 2004, at 3:05:33
Hi Kara,
Yes, it was a bit overwhelming at first. Do you cook? If you do it helps, cause you can have some idea already of the basics that go into certain dishes. The things I find that are the trickiest are salads, sauces, and multi-ingredient dishes like pastas, casseroles, crab cakes, etc. You can't go wrong with a steak, baked potato, and salad without cheese and dressing on the side.I don't carry nifedipine. I started out getting Nardil from my GP, and we never considered it. My pdoc didn't suggest it, and since reports have been mixed, and I am very very careful, I feel okay without it. I do wear a bracelet and have told a trusted few people at work and school what it means, so that if I do have to go to the ER, hopefully it wouldn't be so bad. It may help that I am a psych. intern, too. That may give me some credibility in the ER. Although I could be raving mad at the time.
I guess I mostly don't worry about it, because I think I have the restrictions managed well.
Good thought about acting as if you were already on Parnate. I "practiced" the diet restrictions while washing out my Celexa and Wellbutrin to make sure I could really do it. It was easier than I thought, although I do miss Irish Cheddar and Brie. :(
gg
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