![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by KaraS on January 2, 2005, at 16:07:19
I have a few more questions I'm confused about.
I read a summary of the Sunnybrook study and it said that pepperoni is ok to eat - yet I could have sworn that Scott got a hypertensive crisis from pepperoni. It said that cured and aged meats are off limit but then said that pepperoni is ok. Isn't pepperoni cured? Is baked ham ok?
I read here that only the fermented soy products are the ones you need to stay away from yet I also read a post in the archives here of someone who claimed to have a crisis from pancakes made from a mix. She later looked at the label and saw that it contained soy powder. If you were to go to a restaurant and order pancakes, are you taking a risk?
Are raisins still considered a problem? Someone here also said to look out for raisin paste and tomato paste. ???
Do I need to stay away from all Chinese food? Or do I remember some of you saying that you only go to ones you really trust. Even if it's a good restaurant, how can you know how old the stock is that they use?
The summary I read also said to stay away from kava beans and pods. I have no idea what foods they're used in. It also said to stay away from "Chinese pea pods etc." That's the first I had heard of chinese pea pods being a problem and what does the "etc." refer to?
I'm still concerned about going out to eat and getting steak that has been cooked with some soy sauce/steak sauce on it or going out and getting meatballs that have been prepared using soy protein isolate or concentrate like all of the ones from Trader Joe's.
Don't remember seeing anything about avocadoes in that summary? Are they ok or not?
I wish I could get a copy of the full Sunnybrook report. I know that someone else here asked for it recently but I don't think they received a link for it or instructions on how to get it. I hate all of the gray area here. It's driving me bonkers!!!
k
Posted by gardenergirl on January 2, 2005, at 16:43:13
In reply to more MAOI diet questions - sorry, posted by KaraS on January 2, 2005, at 16:07:19
Hi Kara,
This reply is based on my experience and level of caution only. Your results may vary.> It said that cured and aged meats are off limit but then said that pepperoni is ok. Isn't pepperoni cured? Is baked ham ok?
I stay away from salami and pepperoni and similar sausages. I do eat pork and turkey ground sausage. I never liked pepperoni or salami anyway, so this has not been a problem for me, but I always pick it off of pizza just in case.
>
> I read here that only the fermented soy products are the ones you need to stay away from yet I also read a post in the archives here of someone who claimed to have a crisis from pancakes made from a mix. She later looked at the label and saw that it contained soy powder. If you were to go to a restaurant and order pancakes, are you taking a risk?Wow, this is a new one. I doubt that you would be taking a risk with restaurant pancakes. I am fairly certain I had some at IHOP since I started Nardil and had no problem. You can always ask what is in the batter, though. That's where my printed card comes in handy.
>
> Are raisins still considered a problem? Someone here also said to look out for raisin paste and tomato paste. ??I've eaten raisins with no problem. I have never had raisin paste, but tomato paste in my homemade spaghetti sauce was just fine. It was OLD (in a can), too.
>
> Do I need to stay away from all Chinese food? Or do I remember some of you saying that you only go to ones you really trust. Even if it's a good restaurant, how can you know how old the stock is that they use?I've stayed away from Chinese food since I started an MAOI. This has not been much of a hardship for me. I suppose if it is a place where you can get to know the cook staff or the manager, you could inquire about ingredients and stuff.
>
> The summary I read also said to stay away from kava beans and pods. I have no idea what foods they're used in. It also said to stay away from "Chinese pea pods etc." That's the first I had heard of chinese pea pods being a problem and what does the "etc." refer to?I assume etc. lumps Chinese pea pods with Kava beans and pods. I have had no problem eating sugar snap pea pods (fresh). I've not encountered these ingredients in anything I've wanted to eat, so I haven't had a problem. But I did include them on my card.
> I'm still concerned about going out to eat and getting steak that has been cooked with some soy sauce/steak sauce on it or going out and getting meatballs that have been prepared using soy protein isolate or concentrate like all of the ones from Trader Joe's.
You know, I'm sure I have had soy protein isolate. I initially stayed away from all frozen processed food stuff that included autolyzed yeast extract (it's ubiqitous!!!) and soy protein isolate. But I finally decided that the amounts in these items seem to be small, and I've never had a reaction. I'm not a vegetarian, though, so I probably don't have as much soy protein as a veg. might.
>
> Don't remember seeing anything about avocadoes in that summary? Are they ok or not?I've seen avocadoes listed as a no no, and I've also seen only avoid overly ripe avocadoes. I recently had guacamole with no problem, but I have not had a fresh avocado or a very ripe one since being on Nardil.
> I hate all of the gray area here. It's driving me bonkers!!!It is annoying how much inconsistency there is. I tended to look at which foods showed up the most frequently and avoided them at all costs at first. And then I began to cautiously experiment with the things that were least likely to be a risk based on either people's reports here on Babble or the studies measuring the amount of tyramine. For example, I was only drinking white wine when I first started, but now I drink reds with no problem (I've never liked chianti, so I don't drink that....that one is listed specifically, so I don't know if it's okay or not.) I've also added mozzarella, provolone and goat cheese, as they all seem to be relatively fresh. And Kraft Parmesan "Cheese" in the can...that has been okay, too, although I don't use a large amount.
Start really cautious and and be smart. You'll find what works for you. And you certainly appear to be capable of making good judgements about this. So I am confident you will be okay, unless you really really crave something that is an absolute no no, like blue cheese, draft beer or aged whiskey or something.
gg
Posted by Larry Hoover on January 2, 2005, at 16:48:59
In reply to more MAOI diet questions - sorry, posted by KaraS on January 2, 2005, at 16:07:19
> I wish I could get a copy of the full Sunnybrook report. I know that someone else here asked for it recently but I don't think they received a link for it or instructions on how to get it. I hate all of the gray area here. It's driving me bonkers!!!
>
> kThe instructions on getting a reprint are in this post:
http://www.dr-bob.org/babble/20020718/msgs/113495.html
Dr. Gardner is at Dalhousie now:
http://www.dal.ca/~impart/IMPART_1131.html
Try emailing him.Here are some full-text links:
http://www.vh.org/adult/provider/psychiatry/CPS/19.html
http://www.dr-bob.org/tips/maoi.htmlLar
Posted by Dan Perkins on January 2, 2005, at 17:09:47
In reply to more MAOI diet questions - sorry, posted by KaraS on January 2, 2005, at 16:07:19
Take a deep breath and relax. There is no need to be overly worried about diet interactions with MAOIs, these problems are few and far between and seem to be mostly limited to a small group of people who are very sensitive to tyramine/MAOI.
It can be worrisome at first navigating the MAOI diet, but I think you will soon realize that there really aren't that many foods you need to watch out for.
I was on 70-90mg of Parnate a day for over a year. I ate out at least 1-2 meals per day, I never paid too much attention to the finer points of the diet (though I was careful to avoid things like fermented soy - ie. natto - and I didn't have any very aged cheese), and I never had any problem.
The best advice I can give you would be to post your concerns and read other people's experiences in the message board on Yahoo dedicated to MAOIs. It's a very supportive and knowledgeable group that has a ton of experience with MAOIs and will take the time to answer your questions in detail. Here is the link: http://health.groups.yahoo.com/group/maois/messages/
And here are my experiences with the foods you mentioned:
Pepperoni is fine. I have eaten many a slice of pepperoni pizza while on 70-90mg of Parnate. Same goes for baked ham (even moreso than pepperoni).
I don't see how one could get a crisis from eating pancakes with soy mix in them. I have had many protein shakes containing soy mix while on Parnate. Unless the soy is fermented then it is not a problem, and soy mix is not fermented.
Same goes for soy protein isolate or concentrate. I've had tons of shakes with isolate and concentrate as the main ingredient and never had a problem.
Raisins are not a problem and neither is raisin or tomato paste.
I've never encountered fava beans (I think it's fava, not kava) in anything I've ordered at a restaraunt (and I eat out a lot). It's just not an ingredient that is likely to be put in a dish without being explicitly listed. And I've never heard of Chinese pea pods or any other pea pods being a problem.
Avocados are no problem at all!
And I've never had a problem with soy sauce either. As long as you don't have a ton of the stuff, you should be fine. So, even if the steak is marinated in soy sauce, it's not a problem.
Posted by KaraS on January 2, 2005, at 17:36:31
In reply to Re: more MAOI diet questions - sorry, posted by Dan Perkins on January 2, 2005, at 17:09:47
THANK YOU ALL SO MUCH FOR ALL OF YOUR HELP!!!!
I think I finally have what I need to relax about this.
...and yes I did mean fava (not kava) beans. (Been hanging out too much on the Alternative Board I guess.)
Happy New Year everyone!
Posted by anastasia56 on January 2, 2005, at 23:20:08
In reply to Re: more MAOI diet questions - thank you, posted by KaraS on January 2, 2005, at 17:36:31
Dan put it most succinctly in his reply so i'd like to second that.
I was on Parnate for a year or so and I don't think I avoided anything really and I was fine...not to say you should do that. My pdoc said most food stuffs in moderation would be fine. I think I was only really aware of the aged meat thing and simply avoided salami. Other than that tho, i didn't even know about soy so never avoided it.
By the way, Parnate was great.
anastasia
Posted by Larry Hoover on January 3, 2005, at 8:24:40
In reply to Re: more MAOI diet questions - thank you, posted by anastasia56 on January 2, 2005, at 23:20:08
> Dan put it most succinctly in his reply so i'd like to second that.
>
> I was on Parnate for a year or so and I don't think I avoided anything really and I was fine...not to say you should do that. My pdoc said most food stuffs in moderation would be fine. I think I was only really aware of the aged meat thing and simply avoided salami. Other than that tho, i didn't even know about soy so never avoided it.
>
> By the way, Parnate was great.
>
> anastasiaThere are some people who are nearly totally resistant to the tyramine pressor effect while on MAOIs. There are others who are exquisitely sensitive to it. If you gathered one hundred people on Parnate together, and fed them identical foods, the blood pressure response would graph as a bell curve. Some would have no response, most would have a moderate response, and some would have an extreme response.
What is critical for any individual using an irreversible MAOI is that they learn about their own sensitivity to tyramine. Stories from others about their own sensitivities do not inform one on this critical issue.
Lar
Posted by sfy on January 3, 2005, at 12:43:36
In reply to more MAOI diet questions - sorry, posted by KaraS on January 2, 2005, at 16:07:19
> I wish I could get a copy of the full Sunnybrook report. I know that someone else here asked for it recently but I don't think they received a link for it or instructions on how to get it. I hate all of the gray area here. It's driving me bonkers!!!
>
> k
>I have a copy of the full Sunnybrook article (it was given to me in a packet of articles by the uber-pdoc who recommended Parnate for me). It's actually rather brief (only 4 pages long) and the Sunnybrook Health Science Centre MAOI Diet is a simple half-page chart. It wouldn't take me too long to type up the chart and make it available. (I could also scan the whole article but there are copyright implications I would run into.)
Posted by sfy on January 3, 2005, at 12:54:44
In reply to more MAOI diet questions - sorry, posted by KaraS on January 2, 2005, at 16:07:19
> I have a few more questions I'm confused about.
>
> I read a summary of the Sunnybrook study and it said that pepperoni is ok to eat - yet I could have sworn that Scott got a hypertensive crisis from pepperoni. It said that cured and aged meats are off limit but then said that pepperoni is ok. Isn't pepperoni cured? Is baked ham ok?The Sunnybrook study says pepperoni is NOT okay to eat. It's specifically listed as one of the foods to avoid. Baked ham isn't a problem - it's not a fermented or dried meat product.
> I read here that only the fermented soy products are the ones you need to stay away from yet I also read a post in the archives here of someone who claimed to have a crisis from pancakes made from a mix. She later looked at the label and saw that it contained soy powder. If you were to go to a restaurant and order pancakes, are you taking a risk?
As Larry said, this would depend on your individual risk factor.
> Do I need to stay away from all Chinese food? Or do I remember some of you saying that you only go to ones you really trust. Even if it's a good restaurant, how can you know how old the stock is that they use?
Sunnybrook says that soy sauce and other soybean condiments are to be avoided so Chinese food might prove a dicey proposition.
> The summary I read also said to stay away from kava beans and pods. I have no idea what foods they're used in. It also said to stay away from "Chinese pea pods etc." That's the first I had heard of chinese pea pods being a problem and what does the "etc." refer to?
Sunnybrook says avoid fava beans or "broad bean pods." I don't know if that includes Chinese pea pods or not.
> Don't remember seeing anything about avocadoes in that summary? Are they ok or not?Avocadoes are OK. The only fruit-related item listed to avoid is banana peel.
Posted by KaraS on January 3, 2005, at 12:57:07
In reply to Re: more MAOI diet questions - thank you, posted by anastasia56 on January 2, 2005, at 23:20:08
> Dan put it most succinctly in his reply so i'd like to second that.
>
> I was on Parnate for a year or so and I don't think I avoided anything really and I was fine...not to say you should do that. My pdoc said most food stuffs in moderation would be fine. I think I was only really aware of the aged meat thing and simply avoided salami. Other than that tho, i didn't even know about soy so never avoided it.
>
> By the way, Parnate was great.
>
> anastasia
Thanks. Why did you stop the Parnate? Did it poop-out?K
Posted by KaraS on January 3, 2005, at 13:00:17
In reply to Re: more MAOI diet questions - sorry » KaraS, posted by sfy on January 3, 2005, at 12:43:36
> > I wish I could get a copy of the full Sunnybrook report. I know that someone else here asked for it recently but I don't think they received a link for it or instructions on how to get it. I hate all of the gray area here. It's driving me bonkers!!!
> >
> > k
> >
>> I have a copy of the full Sunnybrook article (it was given to me in a packet of articles by the uber-pdoc who recommended Parnate for me). It's actually rather brief (only 4 pages long) and the Sunnybrook Health Science Centre MAOI Diet is a simple half-page chart. It wouldn't take me too long to type up the chart and make it available. (I could also scan the whole article but there are copyright implications I would run into.)
>
>Hi,
Larry included some great sources in his first response here. One of them had a chart that was a half page long. Is that the same chart by any chance? If not, then I would definitely be interested in seeing the one from Sunnybrook.
Thank you!K
Posted by sfy on January 3, 2005, at 15:42:59
In reply to Re: more MAOI diet questions - sorry » sfy, posted by KaraS on January 3, 2005, at 13:00:17
> Hi,
>
> Larry included some great sources in his first response here. One of them had a chart that was a half page long. Is that the same chart by any chance? If not, then I would definitely be interested in seeing the one from Sunnybrook.
> Thank you!
>
> KThe article Larry posted a link to (http://www.vh.org/adult/provider/psychiatry/CPS/19.html)
reproduces the Relative Restrictions of Foods and Beverages With MAOI Use table (Table 7) from the Sunnybrook study. However, the Sunnybrook MAOI Diet table is not included. I'm going to try and put it together by tomorrow.I would also pay heed to Dr. Ivan Goldberg's comments on http://www.dr-bob.org/tips/maoi.html. (He is a friendly and knowledgeable pdoc I first encountered on another support site some 10 years ago who has welcomed brief email inquiries in the past)
Posted by jclint on January 3, 2005, at 15:49:17
In reply to Re: more MAOI diet questions - sorry » sfy, posted by KaraS on January 3, 2005, at 13:00:17
>Larry included some great sources in his first response here. One of them had a chart that was a half page long. Is that the same chart by any chance? If not, then I would definitely be interested in seeing the one from Sunnybrook.
Thank you!>K
Me too. I would appreciate it greatly. It sucks that such information is so hard to obtain.
J
Posted by jclint on January 3, 2005, at 16:09:11
In reply to Re: more MAOI diet questions - sorry, posted by jclint on January 3, 2005, at 15:49:17
Also, this post linked on the pyscho-babble MAOI Diet page may be the same text perhaps.
Posted by KaraS on January 3, 2005, at 16:37:48
In reply to Re: more MAOI diet questions - sorry » KaraS, posted by sfy on January 3, 2005, at 15:42:59
> > Hi,
> >
> > Larry included some great sources in his first response here. One of them had a chart that was a half page long. Is that the same chart by any chance? If not, then I would definitely be interested in seeing the one from Sunnybrook.
> > Thank you!
> >
> > K
>
> The article Larry posted a link to (http://www.vh.org/adult/provider/psychiatry/CPS/19.html)
> reproduces the Relative Restrictions of Foods and Beverages With MAOI Use table (Table 7) from the Sunnybrook study. However, the Sunnybrook MAOI Diet table is not included. I'm going to try and put it together by tomorrow.
>
> I would also pay heed to Dr. Ivan Goldberg's comments on http://www.dr-bob.org/tips/maoi.html. (He is a friendly and knowledgeable pdoc I first encountered on another support site some 10 years ago who has welcomed brief email inquiries in the past)
>
>Funny you should mention Dr. Goldberg as I've been reading on his site all morning. I'll read your links as well. Thanks again for all your help!
Posted by anastasia56 on January 3, 2005, at 16:42:03
In reply to Re: more MAOI diet questions - thank you » anastasia56, posted by KaraS on January 3, 2005, at 12:57:07
oddly enough it was plain old allergies that induced me to get off parnate. I have a boatload of allergies and apparently you cannot take the emergency drugs for a bad allergy attack when you are on parnate. I can't remember if it was the emergency epinephrine shot or not. I was going to start a thread to see if anyone has first hand experience with this as i would like to go back on parnate. I just panicked and went off it without doing a lot of research.
anastasia
Posted by KaraS on January 3, 2005, at 16:53:53
In reply to Re: more MAOI diet questions - thank you » KaraS, posted by anastasia56 on January 3, 2005, at 16:42:03
> oddly enough it was plain old allergies that induced me to get off parnate. I have a boatload of allergies and apparently you cannot take the emergency drugs for a bad allergy attack when you are on parnate. I can't remember if it was the emergency epinephrine shot or not. I was going to start a thread to see if anyone has first hand experience with this as i would like to go back on parnate. I just panicked and went off it without doing a lot of research.
>
> anastasiaI recently have developed asthma but have a lot of other allergies too. Actually I'm hoping that it's all stress and panic instead of asthma but I will be checking this out with a doctor and researching treatments myself before I go on an MAOI. I'll let you know if I find anything important.
K
Posted by KaraS on January 3, 2005, at 17:02:17
In reply to Re: more MAOI diet questions - sorry, posted by jclint on January 3, 2005, at 15:49:17
I have read a study (and saw it referred to on PB) about the safety of pepperoni. I've also seen it placed on safe lists for MAOIs. Someone on the MAOI Yahoo board has been telling everyone that it's safe to consume. She's been stating that as a certainty.
I've also seen pepperoni listed as dangerous on other current lists. Then I came across this post from Todd (King Vultan) that I think explains the situation well. I will try to repost this on the Yahoo board:
"Pizza can be a problem, especially pepperoni, and especially on Parnate because that is the more dangerous of the two MAOIs as far as generating hypertensive crises. I've read at least two anecdotes by different people on Parnate who suffered hypertensive crises after eating pepperoni pizza. However, studies done up at Sunnybrook, Toronto by Dr. Shulman, et al, showed nearly zero tyramine in Pizza Hut and Domino's double cheese double pepperoni pizzas. I do believe the two people who suffered hypertensive crises on Parnate did eat at smaller, unaffiliated local pizza places, with perhaps more aged/authentic pepperoni. I get pizzas myself from the Papa Murphy's take them home and cook them chain, and I do not select their pepperoni, because my impression is that it is higher quality and possibly more aged than what you might find on a Domino's pizza. I also specify mozzarella only, as Papa Murphy's normally use a three cheese blend."
Posted by eeyorena on January 3, 2005, at 18:19:50
In reply to Re: more MAOI diet questions - thank you » anastasia56, posted by KaraS on January 3, 2005, at 16:53:53
I've been on Parnate for a little over two years and it is (seriously!) one of the best AD's I've tried. I resisted it SO MUCH because of the tyramine diet. But I tried everything else to no avail.
I have chronic allergies and you cannot take many over the counter allergy meds.
But there are certain allergy medications you can take. I've been on Allegra along with Parnate with the blessing of two doctors. So there are some oral med allergy treatments. And there are many nasal sprays that are also excellent.
Take care--
Posted by Dan Perkins on January 3, 2005, at 18:38:30
In reply to Re: more MAOI diet questions - pepperoni issue, posted by KaraS on January 3, 2005, at 17:02:17
I can only speak for myself, but I ate numerous slices of pepperoni pizza from several different pizza places while I was on Parnate (70-90mg/day) and never had a problem.
Posted by sfy on January 3, 2005, at 19:54:20
In reply to Re: more MAOI diet questions - sorry, posted by jclint on January 3, 2005, at 16:09:11
> Also, this post linked on the pyscho-babble MAOI Diet page may be the same text perhaps.
>
> http://www.dr-bob.org/babble/20010804/msgs/73614.htmlNo, this is a companion study. The article with the Sunnybrook diet in it is:
Gardner DM, Shulman KI, Walker SE, Tailor SA.
The making of a user friendly MAOI diet.
J Clin Psychiatry. 1996 Mar;57(3):99-104.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8617704
Posted by sfy on January 3, 2005, at 20:05:14
In reply to Re: more MAOI diet questions - pepperoni issue, posted by KaraS on January 3, 2005, at 17:02:17
> I have read a study (and saw it referred to on PB) about the safety of pepperoni. I've also seen it placed on safe lists for MAOIs. Someone on the MAOI Yahoo board has been telling everyone that it's safe to consume. She's been stating that as a certainty.
>
> I've also seen pepperoni listed as dangerous on other current lists. Then I came across this post from Todd (King Vultan) that I think explains the situation well. I will try to repost this on the Yahoo board:
>
> "Pizza can be a problem, especially pepperoni, and especially on Parnate because that is the more dangerous of the two MAOIs as far as generating hypertensive crises. I've read at least two anecdotes by different people on Parnate who suffered hypertensive crises after eating pepperoni pizza. However, studies done up at Sunnybrook, Toronto by Dr. Shulman, et al, showed nearly zero tyramine in Pizza Hut and Domino's double cheese double pepperoni pizzas. I do believe the two people who suffered hypertensive crises on Parnate did eat at smaller, unaffiliated local pizza places, with perhaps more aged/authentic pepperoni. I get pizzas myself from the Papa Murphy's take them home and cook them chain, and I do not select their pepperoni, because my impression is that it is higher quality and possibly more aged than what you might find on a Domino's pizza. I also specify mozzarella only, as Papa Murphy's normally use a three cheese blend."
>This companion study by Drs. Shulman and Walker was published in 1999, three years after the Sunnybrook Diet study was issued. It also looked at soy products. The abstract reads:
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.
Shulman KI, Walker SE.
Refining the MAOI diet: tyramine content of pizzas and soy products.
J Clin Psychiatry. 1999 Mar;60(3):191-3.
Posted by KaraS on January 3, 2005, at 20:40:18
In reply to Re: more MAOI diet questions - thank you, posted by eeyorena on January 3, 2005, at 18:19:50
> I've been on Parnate for a little over two years and it is (seriously!) one of the best AD's I've tried. I resisted it SO MUCH because of the tyramine diet. But I tried everything else to no avail.
>
> I have chronic allergies and you cannot take many over the counter allergy meds.
>
> But there are certain allergy medications you can take. I've been on Allegra along with Parnate with the blessing of two doctors. So there are some oral med allergy treatments. And there are many nasal sprays that are also excellent.
>
> Take care--
>
>
> http://happynothappy.blogspot.com
Thanks. I think that most antihistamines are fine. It's the more hardcore asthma treatments that I'm worried about (like the bronchodilators). We'll see. Good to know you're doing so well on Parnate. Hope it's as good for me.Take care and thanks for the blog link.
K
Posted by KaraS on January 3, 2005, at 20:58:10
In reply to Re: more MAOI diet questions - pepperoni issue » KaraS, posted by sfy on January 3, 2005, at 20:05:14
> > I have read a study (and saw it referred to on PB) about the safety of pepperoni. I've also seen it placed on safe lists for MAOIs. Someone on the MAOI Yahoo board has been telling everyone that it's safe to consume. She's been stating that as a certainty.
> >
> > I've also seen pepperoni listed as dangerous on other current lists. Then I came across this post from Todd (King Vultan) that I think explains the situation well. I will try to repost this on the Yahoo board:
> >
> > "Pizza can be a problem, especially pepperoni, and especially on Parnate because that is the more dangerous of the two MAOIs as far as generating hypertensive crises. I've read at least two anecdotes by different people on Parnate who suffered hypertensive crises after eating pepperoni pizza. However, studies done up at Sunnybrook, Toronto by Dr. Shulman, et al, showed nearly zero tyramine in Pizza Hut and Domino's double cheese double pepperoni pizzas. I do believe the two people who suffered hypertensive crises on Parnate did eat at smaller, unaffiliated local pizza places, with perhaps more aged/authentic pepperoni. I get pizzas myself from the Papa Murphy's take them home and cook them chain, and I do not select their pepperoni, because my impression is that it is higher quality and possibly more aged than what you might find on a Domino's pizza. I also specify mozzarella only, as Papa Murphy's normally use a three cheese blend."
> >
>
> This companion study by Drs. Shulman and Walker was published in 1999, three years after the Sunnybrook Diet study was issued. It also looked at soy products. The abstract reads:
>
> 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.
>
> Shulman KI, Walker SE.
> Refining the MAOI diet: tyramine content of pizzas and soy products.
> J Clin Psychiatry. 1999 Mar;60(3):191-3.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10192596
>
>Yes, I had read that abstract about the pepperoni being safe. That was one of the reasons for my confusion because I had also read about others (including SLS) having reactions to pepperoni. I think that what Todd said makes sense. The abstract measured the pepperoni from the pizza chains. The pepperoni from the chains is probably ok but the better, more aged pepperoni may be dangerous.
I also noticed that one of the links that Larry provided showed from their tests that mozarella was a problem too. Yet every other source seems to say that mozarella is no problem. Judging from the number of people who are successfully eating it, I'm not really that concerned about it though. Also, I haven't read where a single person has had a bad reaction to it yet.
K
Posted by KaraS on January 3, 2005, at 21:01:05
In reply to Re: more MAOI diet questions - pepperoni issue, posted by Dan Perkins on January 3, 2005, at 18:38:30
> I can only speak for myself, but I ate numerous slices of pepperoni pizza from several different pizza places while I was on Parnate (70-90mg/day) and never had a problem.
I wonder if you always get your pizza from a chain or whether you've tried all different levels of aged pepperoni. Sometimes, as Larry said, it just comes down to individual chemistry. Are you able to eat a lot of things that are on the newer prohibited lists?
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