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Dr. Bob is Robert Hsiung, MD,
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Posted by jsarirose on July 22, 2002, at 3:03:54
In reply to Re: MAOI diet short list, posted by cybercafe on July 22, 2002, at 2:56:24
> > To add to the list - remember any pastes are not allowed at all! For example fish paste & anchovy paste. May sound like something you'd never eat, but they actually use some of those pastes in some of the Asian soups. I was sick from some Vietnamese Pho which I found out contains anchovy paste.
>
> really? my mom keeps trying to push the paste on me...
>
> jess you have saved my butt yet again ...
>
> ... i am going to have to recommend you charge my health care insurance $500Well, toothpaste is okay! You still have to brush, sorry. ; )
-Jessica
ps - shrimp paste is another
Posted by LLL on July 22, 2002, at 10:02:07
In reply to Re: MAOI diet short list » LLL, posted by jsarirose on July 22, 2002, at 3:02:33
> Jess, as always, thank you for your thorough responses. I still have questions because I clearly recall using the frozen diet dinners "Lean Cuisine" etc., the last time I was on Parnate with no incidents and those dinners as well as the other brand names list yeast extract, yeast, or autolyzed yeast extract. I may call the manufacturer because the amount may be so small that restricting the use would be unnecesary.
Raspberries are listed as both not a problem and as a problem in these lists (I have them all). So it makes me question things like bottled raspberry viniagrette dressing. And - if peanuts in large quantity is prohibited - what about peanut butter?
I've written to 2 pharmacists on line and received a response from one who will try to help me further- he's in the UK. This is what he's told me thus far:
The trouble is that there are two problems:
1. Some people are rapid metabolisers of tyramine and in fact hardly need to have a restricted diet
2. Hard data on the exact tyramine content of foods is lacking, and even
then there are variations between brands, it changes over time and one study
even showed local concentrations in one piece of cheese - one chunk had none, another chunk next to it would blow your head off!
I'll post what I find out.
Lisa
Posted by jsarirose on July 22, 2002, at 10:41:32
In reply to Re: MAOI diet short list, posted by LLL on July 22, 2002, at 10:02:07
Please do post if you get a response.
When I see conflicting reports I always look at the date and go with the later one. Usually, it is an item they thought was not allowed and then they realize it's fine.
I've never heard of raspberries causing any trouble and I've eaten fresh raspberries, frozen raspberries, and raspberry jam. Judging from my reaction to other items I would guess I'm a "rapid metabolizer".
And I believe the same is true with peanuts except in very high quantities. I've successfully eaten more peanut butter & jelly sandwiches than I care to admit (and I use pure ground peanuts and don't put it on sparsely).
Some things, like chocolate, do contain tyramine in studies but in practicality you would have to consume so much it really would be difficult to get a reaction. They still tend to include them on the 'use in small quantities' lists though.
There is a list on the web of actual tyramine content in a variety of foods. Here's one (I've seen others but can't find any good ones right now): http://www.migraene.dk/Engelsk/triggers/Tyraminmigr%C3%A6ne-english.htm
General rule of thumb, I believe, is greater than 6mg/serving is a no no, while less than that is allowable in increasing moderation as it nears 6mg.
Another stat for you: A person (not on MAOI) can safely ingest 100mg of tyramine. As the amount increases their blood pressure will increase. 400-500mg causes hypertension. Taking an MAOI causes a 50-fold effect on tyramine levels, hence 6mg of tyramine = 300mg for a "normal" person.
(Paraphrased from a couple sites, including: http://nepenthes.lycaeum.org/Drugs/Misc/maoidisc.html)-Jessica
Posted by jsarirose on July 22, 2002, at 10:53:52
In reply to Re: MAOI diet short list » LLL, posted by jsarirose on July 22, 2002, at 10:41:32
Found one more tidbit: "Approximately 10 to 25 mg of tyramine is required for a severe reaction compared to 6 to 10 mg for a mild reaction." (Source: http://nepenthes.lycaeum.org/Misc/maoi.foods.html)
Granted, this is an older list, but I would think the above rule of thumb is still accurate.And here's an answer to a question I had a while back but never could get answered. I was wondering if you had several items that were each acceptable in small doses if the total effect could give you a reaction. And, how long does it take to clear your system of tyramine. For example, if I had a bunch of coffee in the morning, could I have a bunch more at night? Anyway: "Tyramine gets digested pretty quickly, and likely clears the gut in 12 hours or so."
(Source: http://www.erowid.org/chemicals/maois/maois_info7.shtml)Okay - think I'm done browsing for now (maybe). : )
-Jessica
Posted by LLL on July 22, 2002, at 11:03:16
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 10:53:52
Thanks again. I think I've already read everything out there and have become addicted to my computer as a result! Do you use peanut butter? What about frozen name brand meals/dinners?
Lisa
Posted by jsarirose on July 22, 2002, at 11:15:36
In reply to Re: MAOI diet short list, posted by LLL on July 22, 2002, at 11:03:16
> Thanks again. I think I've already read everything out there and have become addicted to my computer as a result! Do you use peanut butter? What about frozen name brand meals/dinners?
> LisaYes, peanut butter in cooking and sammiches. I've shied away from frozen dinners that contain autolyzed yeast (which is most anything with a sauce). I'm still not convinced that the amount would be enough to trigger an episode, but I'm pretty gun shy these days. When I first started on Parnate I would chance things more and taste more things. Now, after three episodes, I would rather err on the side of caution. I would just love to find some data on the actual mg of tyramine contained in an average serving of something containing autolyzed yeast though. Any friends that are chemists?
-Jessica
(ps - I've found some of the more expensive organic ones don't contain the yeast)
Posted by LLL on July 22, 2002, at 11:48:53
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 11:15:36
I wrote to "Lean Cuisine" and "Healthy Choice" and am hoping to get something back that will be helpful.
Received word from my general practioner in regard to prescribing an antidote for the Parnate - to quote his nurse "he won't touch it." Don't blame him - it's the psychiatrist's responsiblity! I'm sooooo frustrated!
Posted by jsarirose on July 22, 2002, at 11:55:11
In reply to Re: MAOI diet short list, posted by LLL on July 22, 2002, at 11:48:53
> I wrote to "Lean Cuisine" and "Healthy Choice" and am hoping to get something back that will be helpful.
> Received word from my general practioner in regard to prescribing an antidote for the Parnate - to quote his nurse "he won't touch it." Don't blame him - it's the psychiatrist's responsiblity! I'm sooooo frustrated!That is sooo unbelievable! He'll prescribe the Parnate but not the 'just in case' pill? (Is he the one prescribing the Parnate?) That seems highly irregular and dangerous. If he's so uncomfortable prescribing the emergency pill he shouldn't be prescribing Parnate!
-Jessica
(Please correct me if I'm wrong.)
Posted by LLL on July 22, 2002, at 12:00:07
In reply to Re: MAOI diet short list » LLL, posted by jsarirose on July 22, 2002, at 11:55:11
My Psych. is the one prescribing the Parnate and not the antidote and pushing me off on my G.P. Yep, I agree it's her responsibility! I have no other psych. to turn to right now and am just plain stuck! I asked my G.P. if he'd call her and talk some sense into her and I'm awaiting a reply.
Thanks,
Lisa
so glad to hear peanut butter's OK!!!! :-)
Posted by cybercafe on July 22, 2002, at 13:29:19
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 10:53:52
>acceptable in small doses if the total effect could give you a reaction. And, how long does it take to clear your system of tyramine. For example, if I had a bunch of coffee in the morning, could I have a bunch more at night? Anyway: "Tyramine gets digested pretty quickly, and likely clears the gut in 12 hours or so."
i'm sure it must depend on how much there is to begin with...
.... if say 50% is metabolized after 30 min, you could probably get away with .... one half the max tyramine content every half hour.... or... 31% every fifteen minutes...
the half life of tyramine in a beverage must be much less than that in a solid since it can make it's way down the alimentary canal much more easily, and has a greater surface area and is more more easy to break down (being liquid) etc etc etc
Posted by Bobbiedobbs on July 23, 2002, at 23:01:32
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 2:52:50
Re one poster's question about soy products, I spoke today with GlaxoSmithKline's expert (via a customer service rep) who said soy protein and soy flour are safe to eat to the extent that they are not "aged or fermented in any way." As to whether they are or not, they said I'd have to contact the soy products manufacturers. That leaves open the question. I suggested that the drug maker update their food list to reflect soy-based products. They (apparently) don't intend to, as there are too few people taking this product to justify the effort. I agree with Jessica's earlier post regarding soy and soy flour, Marsala wine in cooking and chicken broth made without yeast (all safe). But that's just my opinion.
The list published by Strong Memorial Hospital Pharmacists in 1998, which appeared on the Univ. of Rochester web site, said to "avoid" "soy sauce and other soybean condiments" but that "soy milk" was specifically "allowed." It also said that no more than 4 ounces of wine per day was OK. Another site says you can consume a "moderate" (defined as 1/4 to 1/2 cup total per day) of the TOTAL of a wide array of items, including, among others: buillon, commercial breads without or low in yeast, MSG, and terriyaki sauce (which it specifically limits to 2-4 tbsp a day).
One poster requested the address to get a copy of the University of Toronto study - which I believe is the most definitive to date on MAOs. I don't know if this is still a good address, but in 1996, I wrote to Kenneth I. Shulman MD, Dpt. of Psychiatry, Sunnybrook Health Science Center, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5 and received a detailed response to my questions. The phone (again back in 96) was 416-480-4079. The name of the study is, "The Making of a User Friendly MAOI Diet," by David Gardner, Kenneth Shulman, Scott Walker and Sandra Tailor. Reprint requests to: Kenneth Shulman, M>D. S.M. F.R.C.P. (C), Dept. of Psychiatry, and the rest as above. This diet says that MSG, soy milk and yeast extracts except Marmite are fine but to avoid soy sauce and soy condiments. It goes into enormous detail. They studied )a) how much tyramine was actually in a variety of food products and (b) whether there has actually been any documented instances of reactions to any of the no-nos. Conclusion: ""Many MAO diets are excessively restrictive and without solid science." For those who drink or want to drink beer and alcohol, there's a second study that lists the amount of tyramine in hundreds of beers. It is called, "Hypertensive Episode Associated with Phenelzine and Tap Beer...". available at the same address from Sandra Tailor. Everything was fine except a bottle of Kronenbourg on tap (horror show) and tap versions of Upper Canada Lager and Rotterdam Lager. None of the bottled or canned beers presented any problem. The conclusion was that it is not the alcohol, but the process in which certain tap is made - a secondary fermentation process which apparently allows bacterial growth and tyramine production. This process does not occur in the popular, bottled beers.
Sunnybrook Health Science Center's MAOI Diet, which I generally follow, says to avoid all cheese except fresh cottage cheese, cream, ricotta, processed cheese slices, and allows no more than 2 domestic bottled or canned beers (including nonalcoholic) or 4 fluid ounces glasses of red or white wine per day.
Phil
Posted by Bobbiedobbs on July 23, 2002, at 23:21:15
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
Can't resist one more stab at the TV dinner issue (I believe they are now referred to as "frozen dinners."). I did a more careful estimate and figure I have consumed approximately 4,000 frozen dinners, the great majority of them which listed autolyzed yeast, etc., among their ingredients, without THE SLIGHTEST reaction. This on up to 60 mg. of Nardil and 50 mg. of Parnate. Not to be glib, but I'd worry more about the chemical soup in the frozen dinners generally.The frozen dinners help me with portion control, plus they are better than anything I could cook without alot of effort - particularly most of the Lean Cuisine products.
Posted by jsarirose on July 23, 2002, at 23:22:21
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
It also said that no more than 4 ounces of wine per day was OK. Another site says you can consume a "moderate" (defined as 1/4 to 1/2 cup total per day)
> Sunnybrook Health Science Center's MAOI Diet, which I generally follow, says to avoid all cheese except fresh cottage cheese, cream, ricotta, processed cheese slices, and allows no more than 2 domestic bottled or canned beers (including nonalcoholic) or 4 fluid ounces glasses of red or white wine per day.
> PhilWith cheeses, don't take the lists provided as total - basically fresh cheeses (what they list) are fine, including mozzarella! If you're craving a cheese that melts, like I was, mozzarella is your friend! Plus, they seem to come out with new cheeses all time. I always find out if it's a "fresh" vs. aged cheese and go for it if I'm positive it's fresh. (Usually the white creamy cheeses.)
RE: soy sauce, I've seen numerous sites that say it's okay in limited amounts, no more than a tbsp. Since I've been fine on that, I see no reason to exclude it from my diet. (Personal choice.)
RE: alcohol. I have also ready varying amounts for red and white wines, and beer some more generous than others. I, personally, have interpreted this to be 'in moderation'. I have had as much as three glasses of red wine & champagne in an evening with no averse effects. I've also had three or so beers and been just fine.
The issue with beer, is as Bobbie said - the danger lies in possible moldy or unclean processes. That's why tap beer & homemade beer are no's, and some of the smaller microbrews are questionable and therefore taboo (in my mind). I also extrapolated this to mean the homemade wine my friend gave me should be totally off limits. (Didn't want to chance it.)
I've had all types of hard liquors, in moderation, with no adverse effects as well.
Please note: these are MY opinions and MY experiences, your mileage may vary.
-Jessica
Posted by jsarirose on July 23, 2002, at 23:26:06
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
I have a new question that I haven't been able to get answered:
I've had numerous (legal) fresh mushrooms, many types of wild, with no ill effect. And I wouldn't expect any.
I'm wondering about dried mushrooms, for instance, shitakes often come dried. I don't think they are technically aged so they should be okay, but sometimes they look like they've been around a while. Any idea if they're okay? Any guesses on whether you think they would be okay?
-Jessica
Posted by LLL on July 24, 2002, at 8:47:26
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
My heartfelt thanks to you both for these 3 posts.
Lisa
Posted by LLL on July 24, 2002, at 9:28:58
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
Somehow my prior thread got mixed up with someone commenting on mood disorders. Want to thank you both, Jess and Phil, for being so very helpful and patient. As my anxiety subsides y'all will here from me less. Promise!
Lisa
Posted by jsarirose on July 24, 2002, at 14:03:55
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by LLL on July 24, 2002, at 8:47:26
> My heartfelt thanks to you both for these 3 posts.
> LisaAbsolutely no problem! That's what these lists are for - sharing information. And I know from my own struggles with trying to get a grasp of the intricacies of the "diet" that it takes a while to really understand it. Soon you'll be able to make your own educated decision on many items.
Of course, we all need to post questions from time to time - hence my question about dried mushrooms.
Take care,
Jessica
Posted by cybercafe on July 24, 2002, at 16:26:22
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
Hey thanks a lot Philthey are quite good there -- not only do they answer their phone lines, but apparently i can go down there and pick up a copy for free...
i'm just wondering though.. does it list the tyramine content of different brands of soy sauce ?
btw - yes it's still the correct phone no for Dr. Shulman's secretary
hmmm... actually the 1999 report seems interesting too:
Refining the MAOI Diet: Tyramine Content of Pizzas and Soy Products
Kenneth I. Shulman, M.D., S.M., F.R.C.P.(C)., and Scott E. Walker, M.Sc.Pharm.(J Clin Psychiatry 1999;60:191Ð193)
--------------------------------------------------------------------------------Received March 22, 1998; accepted June 30, 1998. From the Departments of Psychiatry (Dr. Shulman) and Pharmacy (Mr. Walker), University of Toronto, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Reprint requests to: Kenneth I. Shulman, M.D., Department of Psychiatry, Sunnybrook Health Science Centre, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada.
Posted by cybercafe on July 24, 2002, at 20:14:37
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 24, 2002, at 14:03:55
i was talking with my doc about getting relief from the MAOI migraine and he confirmed something i've read concerning effects of noradrenergic receptors ... i.e. they have different effects at different locations in the body!... tyramine causes increased blood pressure by vasoconstriction ... however ... headaches are caused by vasodilation in the head -- blood vessels swell (dilate) and press against nerves ... (i thought we didn't have pain receptors in the head?) ...
so maybe that's why yous were saying nifedepine doesn't work on migraines??
Posted by SLS on July 25, 2002, at 7:22:38
In reply to Re: hypertensive experiences?, posted by ayrity on July 17, 2002, at 23:55:30
Hi Ayrity.
> I have atypical depression and extreme fatigue is the prominent symptom- since Parnate has a stimulant effect we went with that first. My doc prefers Marplan (fewer side effects, though knowing me...) instead of Parnate if the stimulant effect is not required, or as second choice if the Parnate doesn't work out.
I am very interested to know why your doctor would choose Marplan over Nardil. Marplan is most definitely more mild in terms of side effects. However, the "old-timers" characterized Marplan as being a "weaker Nardil". It's non-usage probably led to the drug company to discontinue it years ago. However, there are a significant number of people who respond well to Marplan whom failed to respond to both Nardil and Parnate. I think the drug company was convince to begin selling Marplan again after they received so many requests that it be made available under a "compassionate use" protocol.
Terrence Ketter, MD at Stanford has recommended to a friend of mine that he also prefers Marplan, although I don't know all of his reasons why.
Since Nardil has been so much help to me, I would most definitely want to know why your doctor chose Marplan for you. With Nardil, the most troublesome startup side effect has been severe orthostatic hypotension. I had to literally crawl on all-fours to and from the bathroom and crawl down the stairs backwards. Surely, Nardil is not known to produce episodes of spontaneous hypertension as does Parnate. However, Marplan is probably much less offensive in this regard.
Does your doctor feel that Marplan is as efficacious as Parnate and Nardil?. How does he characterize the advantages of Marplan regarding side effects? Perhaps Marplan has been underestimated in the past such that it can now be justified as a first choice among MAOIs.
I'll say a little prayer on your behalf.
Good luck.
Sincerely,
Scott
Posted by judy1 on July 25, 2002, at 11:09:35
In reply to Re: hypertensive experiences? » ayrity, posted by SLS on July 25, 2002, at 7:22:38
This has nothing to do with this thread, I just wanted your attention :-). I have a thread on Psycho-Psycho Babble (my symptoms on manic psychosis) where I mention your offer to e-mail you when I was getting manic. If you remember any of that, would you mind contributing? Thanks a lot! Now back to regular programming.... Take care, judy
Posted by jsarirose on July 25, 2002, at 13:46:50
In reply to Re: hypertensive experiences? » ayrity, posted by SLS on July 25, 2002, at 7:22:38
"Surely, Nardil is not known to produce episodes of spontaneous hypertension as does Parnate. "
Did you mean to say 'not known to' ? I'm not questioning you at all, I just wasn't aware that this difference existed. I thought people on Nardil had to adhere to the same diet restrictions as those on Parnate and that the same risks were involved. How interesting.
-Jessica
Posted by LLL on July 25, 2002, at 13:50:19
In reply to Re: hypertensive experiences? » ayrity, posted by SLS on July 25, 2002, at 7:22:38
I'm unaware of Parnate causing "spontaneous increases in hypertentsion" without diet/drug violations. Can you please provide the source of your information?
Thanks
Posted by cybercafe on July 26, 2002, at 0:15:21
In reply to Re: hypertensive experiences? » SLS » SLS, posted by jsarirose on July 25, 2002, at 13:46:50
> Did you mean to say 'not known to' ? I'm not questioning you at all, I just wasn't aware that this difference existed. I thought people on Nardil had to adhere to the same diet restrictions as those on Parnate and that the same risks were involved. How interesting.i believe some people commented that parnate can react with it's own stimulant-type metabolites to cause a spontaneous hypertensive crisis? though i imagine this must be quite rare
Posted by cybercafe on July 26, 2002, at 0:21:14
In reply to Re: hypertensive experiences? » ayrity, posted by LLL on July 25, 2002, at 13:50:19
well i went down to sunnybrook today and picked up a copy of "tyramine content of pizzas and soy products" ... it does list the tyramine content of 5 different soy sauces, which isn't too bad...jess: which soy sauces have you tried in the past? ... and were they fresh, or restaurantish?
i am wondering if the "tyramine content in chinese food", Wing Y-K, Chen C-N, journal clinical psychopharmacology 1997, might have yet even more information, but i can't seem to find a copy online .........
.... it would be nice if someday soon, like everyone else, i were to educate myself in matters that actually helped to generate money :)
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