Avoid aged cheeses when on a low-tyramine diet.
Comstock Images/Comstock/Getty Images
Tyramine naturally occurs in a variety of foods, especially those that are aged and fermented. It can cause headaches and increase blood pressure, but you normally don't have to worry about eating tyramine-containing foods because it's inactivated by enzymes in your digestive tract. Some medications interfere with these enzymes, which can make levels of tyramine increase. If you take these medications, your physician may advise you to follow a low-tyramine diet.
Tyramine forms in foods when microorganisms interact with the amino acid tyrosine. It's a normal part of aged and fermented foods and also produced when foods begin to spoil. Antidepressants called monoamine oxidase inhibitors, drugs used to treat Parkinson's disease and certain antibiotics interfere with the enzymes that metabolize tyramine. When you take these medications, levels of tyramine increase in your blood. High levels of tyramine cause the release of too much norepinephrine, which results in side effects such as severe headache, high blood pressure, heart palpitations and confusion. Blood pressure can get so high that it becomes a medical emergency called a hypertensive crisis, according to Vanderbilt University.
Aged, Fermented and Pickled Foods
At least three-fourths of all tyramine-related hypertensive crises are caused by aged cheeses, which is why it's sometimes called a cheese reaction, according to Vanderbilt University. This makes it especially important to eliminate all aged cheese, including cheddar, blue and Swiss. You should avoid any type of aged, smoked or pickled fish, meat and poultry. This category also includes dried sausage, pepperoni, salami, pastrami and corned beef. Do not eat sauerkraut, kimchi and other fermented vegetables. Soybeans, soybean paste, tofu, miso and soy sauce are all high in tyramine.
Other Foods and Beverages
Do not eat freshly baked yeast bread or processed meats such as bologna, bacon, ham and hot dogs, notes Northwestern Memorial Hospital. Bouillon and broth made from meat can be high in tyramine, which means that meat-based soups, stews, sauces and gravies should be avoided. Snow peas, fava beans and Italian green beans are on the do-not-eat list because they're high in another substance that can increase blood pressure and may magnify the effect of tyramine. A low-tyramine diet should not include vermouth, tap beer or wine. You should also eliminate yeast extracts. Banana peels are not commonly consumed in American cuisine, but they're also forbidden.
Old or Spoiled Foods
You would not eat obviously spoiled food, but foods that are close to spoiling can have too much tyramine to be safe. Fruits and vegetables that are overripe can cause problems. Meats that are near the expiration date can already have tyramine-producing bacteria. The bottom line is that you should not eat any meat, fish, poultry or dairy products that are near or beyond the expiration date. Eat fresh produce within 48 hours. Vanderbilt University recommends consuming fresh meat, poultry or fish the same day or putting it directly into the freezer and then thawing it in the refrigerator. Don't eat leftovers after 48 hours.