Posted by Larry Hoover on September 25, 2004, at 12:53:35
In reply to Re: Mozzarella and tyramine studies, posted by King Vultan on September 25, 2004, at 11:28:49
> OTOH, I also have the results of the pizza analyses performed by Drs. Shulman and Walker in 1998, where the tyramine content of mozzarella cheese was retested, and the amount was a mere 0.5 mg per 30 gram serving. The amount of tyramine measured in half a Pizza Hut medium pizza with double cheese and pepperoni was a completely harmless 0.0628 mg total, that in a sample of pizza toppings (the crust was not included) with a mass of 136.5 grams. The authors do caution that this doesn't necessarily mean that all pizzas are safe, as for instance, some gourmet pizzas may contain cheeses of a more aged variety. I also have concerns about pepperoni variations between different chains. I have read two anecdotes of different people experiencing hypertensive crises eating pepperoni pizza at small, local pizza joints while on Parnate.
>
> ToddHere are some Shulman abstracts. Thanks for bringing critical information to light. There is so much misinformation in the "standard medical wisdom". I don't remember seeing draft (or tap) beer as being restricted, or tofu, for that matter.
Lar
J Clin Psychiatry. 1999 Mar;60(3):191-3.
Comment 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.
J Clin Psychopharmacol. 1996 Oct;16(5):383-8.
Comment in:
J Clin Psychopharmacol. 1997 Jun;17(3):226-7; author reply 227-8.
J Clin Psychopharmacol. 1997 Jun;17(3):227; author reply 227-8.Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets.
Walker SE, Shulman KI, Tailor SA, Gardner D.
Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Traditional monoamine oxidase inhibitors (MAOIs) remain an important class of drugs for a variety of psychiatric conditions, including depressive illnesses, anxiety, and eating disorders. It was the objective of this study to refine the MAOI diet by determining the tyramine content of a variety of untested and "controversial" foods that continue to appear on MAOI diet-restricted food lists. A secondary objective of the study was to evaluate the effect of freshness on the tyramine content of some foods. Fifty-one food samples were evaluated for tyramine content by liquid chromatography. Food samples included a selection of sausages, beverages, sliced meat products, including chicken liver, and some fruits, including raspberries, bananas, and banana peels. Foods that were found to have dangerously high concentrations of tyramine (> or = 6 mg/serving) included chicken liver aged 9 days (63.84 mg/30 g), air-dried sausage (7.56 g/30 g), soy sauce (0.941 mg/ml), and sauerkraut (7.75 mg/250 g). Of the foods analyzed in this study, only those with high tyramine content per serving should continue to be absolutely restricted. All other foods are either safe for consumption or safe in moderation. The data provided should be combined with the data from other similar analytical studies to develop a list of foods that should be absolutely restricted. A more accurate list of restricted foods may enhance patient dietary compliance.
Can J Psychiatry. 1997 Apr;42(3):310-2.Tap (draft) beer and monoamine oxidase inhibitor dietary restrictions.
Shulman KI, Tailor SA, Walker SE, Gardner DM.
Department of Psychiatry, University of Toronto, Ontario.
OBJECTIVE: Traditional monoamine oxidase inhibitors (MAOIs) continue to play an important role in the management of a wide variety of clinical conditions. Accordingly, a practical and safe approach to MAOI dietary restrictions remains an essential component of patient management. METHOD: In an effort to refine MAOI dietary recommendations, we report a case of hypertensive crisis following the consumption of a modest amount of tap beer. RESULTS: A well-documented case report involving tap (draft) beer consumed while on an MAOI supports an earlier study, which recommended that all tap beers be restricted on MAOI diets. The 2 cases were remarkably similar in terms of the offending substance, quantity consumed, and subsequent reaction. CONCLUSIONS: As a result of recent tyramine analyses and 2 well-documented case reports, all tap (draft) beers should now be absolutely restricted on MAOI diets because they represent a very significant risk at modest levels of consumption.
poster:Larry Hoover
thread:394544
URL: http://www.dr-bob.org/babble/20040921/msgs/394869.html