![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Diane E. on June 12, 2000, at 16:30:07
I have been reading old posts about MAOI food restrictions and diet. I would like to know more about people's
experiences/information about various types of beer and MAOIs.
In different places I have read:
domestic may be okay, but imported is not
bottled may be okay, but tap is not
only beers "known to be safe" are okayWhat are people's experiences with these rules? Does domestic literally refer to country of origin or does
it really refer to American style lager (e.g., Coors, Bud)? In other words, would American micro-brews fall
into the domestic or imported category? How would one "know" a beer to be safe? Is there an ingredient or
brewing process that makes some more likely to be problematic than others?Adam....I remember reading a while back that you were a lover of good beer and about to start oral MAOIs.
How is it going? What have you learned?Fear not, I realize that no one can promise me anything and that the safest bet is to avoid beer all together. I
am just trying to get a better understanding these distinctions.Thanks for any input.
Diane
Posted by shellie on June 12, 2000, at 23:12:23
In reply to MAOIs and beer (Adam?), posted by Diane E. on June 12, 2000, at 16:30:07
Hi Diane. I was young and foolish when I started on nardil and ate and drank everything, trying a little bit at a time, until I didn't do any restrictions. Luckily, I've never had a reaction. I absolutely don't advise that. My friend, also on nardil, was able to drink beer but not imported ale. When we were out she got a horrible headache immediately after drinking bottled ale and I took her to the emergency room. Her bp was up, but not dangerously. So please be careful. shellie
> I have been reading old posts about MAOI food restrictions and diet. I would like to know more about people's
> experiences/information about various types of beer and MAOIs.
> In different places I have read:
> domestic may be okay, but imported is not
> bottled may be okay, but tap is not
> only beers "known to be safe" are okay
>
> What are people's experiences with these rules? Does domestic literally refer to country of origin or does
> it really refer to American style lager (e.g., Coors, Bud)? In other words, would American micro-brews fall
> into the domestic or imported category? How would one "know" a beer to be safe? Is there an ingredient or
> brewing process that makes some more likely to be problematic than others?
>
> Adam....I remember reading a while back that you were a lover of good beer and about to start oral MAOIs.
> How is it going? What have you learned?
>
> Fear not, I realize that no one can promise me anything and that the safest bet is to avoid beer all together. I
> am just trying to get a better understanding these distinctions.
>
> Thanks for any input.
> Diane
Posted by Cam W. on June 12, 2000, at 23:26:49
In reply to MAOIs and beer (Adam?), posted by Diane E. on June 12, 2000, at 16:30:07
Diane - It is the tyramine content of food that is the problem with MAOIs. Monoamine oxidase metabolizes tyramine and when you block this enzyme with an MAOI, tyramine builds up in the body causing the headaches and increased blood pressure. Tyramine is basically found in any aged foods (eg many cheeses - not in processed cheese; beef jerky; good red wine; pickled herring; etc). I guess the older the beer, the more likely you would be to have a reaction to it (because the older it is, the more tyramine it contains).
Hope this helps - Cam
Posted by Adam on June 13, 2000, at 10:25:40
In reply to MAOIs and beer (Adam?), posted by Diane E. on June 12, 2000, at 16:30:07
Hi, Diane,
I have very cautiously consumed both bottled and tap beer. I have yet to have a reaction. I have avoided certain beers because of suspicion, though I have little or no empirical evidence to support my suspicious.
This is what I will say before I list what I have tried below:
BE CAREFUL, BE CAREFUL, BE CAREFUL, BE CAREFUL, BE CAREFUL, BE CAREFUL, BE CAREFUL, BE CAREFUL, BE CAREFUL, etc.
Anyway (in no particular order):
Pete's Wicked Summer Brew: No problem, bottled.
Sam Adams Lager, Summer Ale, Winter Ale: No problem, bottled (or on tap, for the Lager).
Newcastle Brown Ale: No problem, bottled.
Shipyard (Dad's current favorite brand), different varieties (dark ale, IPA, stout): No problem, bottled.
Harpoon IPA: No problem, bottled.
Gritty McDuff's Blackfly Stout: No problem, bottled (not very tasty bottled, though).
Bud Light: No problem, bottled.
Corona: No problem, bottled.I think that's about it. On no occasion have I consumed more than two bottles over the course of an entire evening.
I have actually eaten two slices of pepperoni pizza from Papa Gino's and had a bottle of Corona (we have these "happy hours" on Fridays after work, with the usual poor food and drink selection), took my b.p. about four hours later, and there was no significant change.
I have eaten a Greek salad with feta cheese on it and those awesome olives, and had a glass of Chardonnay right afteward (don't remember which brand), checked myself a few hours later, and nothing.
Now, one day I ate a piece of chicken that had been sitting in the fridge for three days. It was cold and did not appear spoiled in any way. Within a few hours I had a throbbing headache and could barely tilt my head back. My heart seemed to be skipping a beat or something (though I think it was just bradycardia). My b.p. was about 180/110, which is awfully high for me. I felt it, I knew there was a problem, and my reading confirmed it. I'm assuming it was the chicken, and by this I also assume I am sensitive to some amount of tyramine. I conclude that the things I ate and drank above had less tyramine in them. It is possible that my b.p. has risen as a result of my food consumption, but not to the point that I noticed it.
I have thought of doing actual tests, where I drank a bottle of beer X and then did a time course experiment for changes in b.p. However, this would require a free evening, which I feel like I haven't had in a bajillion years. I may still do it though.
Keep in mind, I always have someone around. I wear a medic-alert necklace. I keep money in pocket in case I have to go to the ER, and make sure someone who knows can take me. I check b.p. whenever I can.
My conclusions, overall: Again, be careful. But, with some hesitation, I believe that with prudence one can enjoy a pretty normal diet on an MAOI without anything really bad happening. However, ALWAYS take precautions, and don't push your luck. I'm not going to be having any meals of fondu or chianti, knowhatimean?
> I have been reading old posts about MAOI food restrictions and diet. I would like to know more about people's
> experiences/information about various types of beer and MAOIs.
> In different places I have read:
> domestic may be okay, but imported is not
> bottled may be okay, but tap is not
> only beers "known to be safe" are okay
>
> What are people's experiences with these rules? Does domestic literally refer to country of origin or does
> it really refer to American style lager (e.g., Coors, Bud)? In other words, would American micro-brews fall
> into the domestic or imported category? How would one "know" a beer to be safe? Is there an ingredient or
> brewing process that makes some more likely to be problematic than others?
>
> Adam....I remember reading a while back that you were a lover of good beer and about to start oral MAOIs.
> How is it going? What have you learned?
>
> Fear not, I realize that no one can promise me anything and that the safest bet is to avoid beer all together. I
> am just trying to get a better understanding these distinctions.
>
> Thanks for any input.
> Diane
Posted by Diane E. on June 13, 2000, at 13:37:58
In reply to Re: MAOIs and beer (Adam?) » Diane E., posted by Adam on June 13, 2000, at 10:25:40
Thank you all for the input. This is just the sort of information I was seeking (especially the list of beers).
It is actually my husband who is going to start Parnate soon (after many, many unsuccessful
trials of many other meds.) and I agreed to help with the background research. We will proceed very,
very, very cautiously. Sounds like we'll need a blood pressure cuff and to gather some baseline
blood pressure data.Thanks,
-Diane
Posted by Adam on June 13, 2000, at 17:21:22
In reply to Re: MAOIs and beer (Adam?), posted by Diane E. on June 13, 2000, at 13:37:58
No problem.
One of the doctors who followed me in the transdermal selegiline study told me that of the Big Three (Marplan, Nardil, Parnate), Parnate may be the worst offender as far as hypertensive reactions go, and this almost got Parnate pulled off of the market permanently. It may have something to do with the fact that the parent compound, or one of its metabolites, is sufficiently amphetamine-like to cause (among other things) increased secretion of norepinepherine. I imagine this leaves the patient with an elevated level of NE in the blood and brain from the get-go (perhaps causing spontaneous hypertensive events in some). Couple that with the massive NE dump that occurs when tyramine dispaces NE in the secretory vessicles in neurons, and the risk for hypertensive crisis might be higher. Again, I'll stress this is just "what I was told", and appears to be based more on anecdotal clinical experience than controlled studies. Still, it's something to think about.
I would say, yes definitely pick up a sphigmomanometer and stethescope. Taking b.p. isn't hard, but if neither one of you is a medical professional, I would have one give you a thorough lesson. I'm lucky enough to have a nurse practitioner for a stepmom, so I got very good training. Also, you may, after learning how, want to try out a few with different variants of cuff before you buy one. I got mine as a present, and while it's quite usable, it's damn hard to take my own b.p. The problem is trying to properly secure the velcro on the cuff with one hand to get the right fit. I get around the problem with some creative use of table tops and a little dexterity, but I sometimes have to repeat measurements (waiting for my arm to return to normal is a pain) because I didn't get the right snugness/looseness ratio. Once I do get it on properly, though, it's easy to pump the bulb and control deflation of the bladder with my left hand while holding the diaphragm of the stethescope, with my right hand, against the brachial artery. Try using the bell of the stethescope to hear those funky sounds with the Russian name (I want to say Kartikov, but I know that's not right), just for kicks.
I guess there are these "portable" automatic units, but they're really expensive. I think I was able to be adequately outfitted for around $100.
Also, get that medic alert braclet or necklace. I like the necklace because A) there's nothing on my wrist to get in the way of my work, and B) nobody asks questions about the necklace, while I think the bracelet is kind of obvious and thus not a very good guard of privacy.
It took a long time to figure out what to put on there. I basically put instructions to call the service and give them my registry number before administering any medications. I just don't trust all the paramedics to know what "sympathomimetic" is (or all the physicians for that matter). Even if they do, I don't imagine all will know offhand which drugs are OK and which one's aren't. However, this does seem a bit too sweeping a precaution, and might cost valuable time.
Any alternative instructions out there? My doctors didn't have any better suggestions.
Thanks!
> Thank you all for the input. This is just the sort of information I was seeking (especially the list of beers).
> It is actually my husband who is going to start Parnate soon (after many, many unsuccessful
> trials of many other meds.) and I agreed to help with the background research. We will proceed very,
> very, very cautiously. Sounds like we'll need a blood pressure cuff and to gather some baseline
> blood pressure data.
>
> Thanks,
> -Diane
Posted by Jennifer on June 13, 2000, at 20:40:03
In reply to Re: MAOIs and beer (Adam?), posted by Adam on June 13, 2000, at 17:21:22
It seems from this thread that we all need to get together and have a beer tasting party. Is Southern California good for everyone else? Actually, I hate beer, except in pancakes!
Here's the deal...it's all in the hops & yeast that are fermented to high heaven in imported (not USA) beer. The only beers that are possibly ok are Domestic (American), non-dark, cheap beers (ie: not aged long) and in glass is best, because glass absorbs tyramine.
Great info from Adam regarding BP measurement. He is 100% correct about Parnate being the worst offender. I think I'd try a Coors in the ER waiting room if at all! Further tips on the BP cuff...you can have inaccurate measurements if it is not the right size. If you are overweight, or overthin...double check it. The WIDTH of the cuff should be 1.5X the width of your upper arm. Length is not of concern as long as it will overlap sufficiently. If it's too narrow, you need to purchase a "thigh cuff". I have had good luck with an electronic one I got at the drug store on sale for $39. You do need to take it a few times when your BP is normal to see what your machine usually measures (since you can't calibrate it)
Adam- you were really lucky with the foods you ate not having a reaction. The number one thing we all need to remember is JUST BECAUSE A FOOD DID NOT GIVE YOU A RXN, DOES NOT MEAN IT WON'T THE NEXT TIME YOU EAT IT! Just as some meds work sometimes, and some don't, your body changes. Also, the tyramine levels in foods change almost hourly. A good rule of thumb is on day three, throw out the leftovers. I do eat avocado when I make guacamole, but I just make enough for 1 night and throw out the rest. (Not that I'm recommending this to anyone). I also enjoy a glass of white wine once in awhile...but not bottled wine coolers because they have hops.
As far as the med alert...MAO should be sufficient because everyone has in the back of their mind that it is something bad, and at least they'll probably double-check before giving meds. I always put "ALLERGIC TO DEMEROL, and NO EPI" (epinephrine) on med sheets. Demerol will send you into an immediate hypertensive crisis. All other narcotic injections should be started at 1/10th the dose, but that's just good to know for after a surgery or something. Epi would really be the only thing I can think of that someone would give you for cardiac or resp reasons after an accident or anaphylactic reaction. The problem is, you're dead without it. Many give it and treat the hypertension later. Always put MAO - no epi, so they know why you can't have it. Why am I always so darn lengthy? I guess I just get on a roll. Hope this helps, Jennifer> No problem.
>
> One of the doctors who followed me in the transdermal selegiline study told me that of the Big Three (Marplan, Nardil, Parnate), Parnate may be the worst offender as far as hypertensive reactions go, and this almost got Parnate pulled off of the market permanently. It may have something to do with the fact that the parent compound, or one of its metabolites, is sufficiently amphetamine-like to cause (among other things) increased secretion of norepinepherine. I imagine this leaves the patient with an elevated level of NE in the blood and brain from the get-go (perhaps causing spontaneous hypertensive events in some). Couple that with the massive NE dump that occurs when tyramine dispaces NE in the secretory vessicles in neurons, and the risk for hypertensive crisis might be higher. Again, I'll stress this is just "what I was told", and appears to be based more on anecdotal clinical experience than controlled studies. Still, it's something to think about.
>
> I would say, yes definitely pick up a sphigmomanometer and stethescope. Taking b.p. isn't hard, but if neither one of you is a medical professional, I would have one give you a thorough lesson. I'm lucky enough to have a nurse practitioner for a stepmom, so I got very good training. Also, you may, after learning how, want to try out a few with different variants of cuff before you buy one. I got mine as a present, and while it's quite usable, it's damn hard to take my own b.p. The problem is trying to properly secure the velcro on the cuff with one hand to get the right fit. I get around the problem with some creative use of table tops and a little dexterity, but I sometimes have to repeat measurements (waiting for my arm to return to normal is a pain) because I didn't get the right snugness/looseness ratio. Once I do get it on properly, though, it's easy to pump the bulb and control deflation of the bladder with my left hand while holding the diaphragm of the stethescope, with my right hand, against the brachial artery. Try using the bell of the stethescope to hear those funky sounds with the Russian name (I want to say Kartikov, but I know that's not right), just for kicks.
>
> I guess there are these "portable" automatic units, but they're really expensive. I think I was able to be adequately outfitted for around $100.
>
> Also, get that medic alert braclet or necklace. I like the necklace because A) there's nothing on my wrist to get in the way of my work, and B) nobody asks questions about the necklace, while I think the bracelet is kind of obvious and thus not a very good guard of privacy.
>
> It took a long time to figure out what to put on there. I basically put instructions to call the service and give them my registry number before administering any medications. I just don't trust all the paramedics to know what "sympathomimetic" is (or all the physicians for that matter). Even if they do, I don't imagine all will know offhand which drugs are OK and which one's aren't. However, this does seem a bit too sweeping a precaution, and might cost valuable time.
>
> Any alternative instructions out there? My doctors didn't have any better suggestions.
>
> Thanks!
>
>
>
> > Thank you all for the input. This is just the sort of information I was seeking (especially the list of beers).
> > It is actually my husband who is going to start Parnate soon (after many, many unsuccessful
> > trials of many other meds.) and I agreed to help with the background research. We will proceed very,
> > very, very cautiously. Sounds like we'll need a blood pressure cuff and to gather some baseline
> > blood pressure data.
> >
> > Thanks,
> > -Diane
Posted by Diane E. on June 14, 2000, at 12:39:22
In reply to Re: MAO/ beer/hops/Med Alert Etc., posted by Jennifer on June 13, 2000, at 20:40:03
Ugh! These last couple of posts have made me very sad. I know I have to share this information
with my husband and I fear it will mean he won't try Parnate. He doesn't believe it will help his
depression (b/c he has tried SO many other meds. that have not helped), so he sees these restrictions
and precautions as very extreme for no benefit. Obviously, he would feel differently if the Parnate
helped, but he can't even imagine it helping in his current state of mind. The Parnate also scares me
because if it does not help, it seems like it will be giving a person with pretty strong suicidal ideations
as very easy means of hurting himself. I'm not sure what I am asking here. I'm just feeling
scared and uncertain of how to proceed. I realize in the end these decisions lie with him, but
he seems to really be at the end of his rope and not able to make good choices for himself.
Thanks for listening.
-Diane
Posted by Adam on June 14, 2000, at 22:51:25
In reply to Re: MAO/ beer/hops/Med Alert Etc., posted by Diane E. on June 14, 2000, at 12:39:22
Dianne,
I had the same fears about Parnate the first time it was suggested to me (about a year-and-a-half ago). No one tried to persuade me to try them, it was just an idea that was floated. At any rate, after responding to an MAOI, I am so happy that I tried it, and I am not at all bothered by the dietary restrictions. It's a more than equitable trade.
I also had tried just about every class of drug under the sun except an MAOI with little success. It's worth it for him to try. Try to make him see that.
I think I remember reading that Parnate is not a particularly lethal drug in overdose, unlike the TCAs, for instance. Also, it's not all that easy to actually kill yourself by eating the wrong foods while on an MAOI. Actual deaths caused by tyramine-related hypertensive crises are very rare. Not to be morbid, but if I was really serious about killing myself, I'd try something else. Probably all I'd get out Parnate + a pound of Stilton cheese is many hours of truly unpleasant illness. Parnate in combination with some medications might be a more serious concern. Perhaps a partial solution would be to put those medications someplace safe and out of reach.
But, really, if your husband is in that much of a risk for suicide, I might think seriously about getting him into a hospital. Perhaps he could start Parnate there.
> Ugh! These last couple of posts have made me very sad. I know I have to share this information
> with my husband and I fear it will mean he won't try Parnate. He doesn't believe it will help his
> depression (b/c he has tried SO many other meds. that have not helped), so he sees these restrictions
> and precautions as very extreme for no benefit. Obviously, he would feel differently if the Parnate
> helped, but he can't even imagine it helping in his current state of mind. The Parnate also scares me
> because if it does not help, it seems like it will be giving a person with pretty strong suicidal ideations
> as very easy means of hurting himself. I'm not sure what I am asking here. I'm just feeling
> scared and uncertain of how to proceed. I realize in the end these decisions lie with him, but
> he seems to really be at the end of his rope and not able to make good choices for himself.
> Thanks for listening.
> -Diane
Posted by Jennifer on June 15, 2000, at 0:36:40
In reply to Re: MAO/ beer/hops/Med Alert Etc., posted by Adam on June 14, 2000, at 22:51:25
Dianne, I TOTALLY AGREE with Adam. It sounds like a ton of stuff to have to get used to, but after the medication works...after nothing else has, you are willing to avoid those minor things you can't have. I would give up much more for how well it worked. I went from "ready to be restrained in a hospital" to "on a picnic with the kids" in 4 days. Awesome! Well worth it!
If he is understanding at this point of any cause & effect, or delayed gratification, explain that it often starts working fairly quickly. If it doesn't work, there are no restrictions after you are off the medication for 2 weeks. Walk him through this and provide wonderful meals within the diet, and other activities instead of beer. Patience is clearly a virtue at this time.
Adam is also right on about ODing...it has the same affect as eating the wrong thing...and there are many things they can do for it in the ER. It may take hours for the affects of an overdose or tyramine intake to be seen, so he would need to be observed at least 12 hours in the emergency room. There are many better ways to commit suicide than with this drug. As a matter of fact, overdosing is the least common reason for having a reaction. Number one is taking another med that reacts to it (allergy, cough/cold, Demerol, asthma etc) Number 2 reason is a food reaction. Both of those are still rare though. I always have the same pharmacist and have him check ALL my medications, not only the prescription ones. Plus I keep a drug book and look them up myself. If you're into exact statistics, they will follow next. If it will only drive you crazy...quit here. JenniferIn the US in 1998 (last year posted) there were 440 exposures to MAO's reported to poison control centers.. Of these, 37 occured in children under 6 years of age, and 352 were in those over age 19. 200 of the total exposures were UNINTENTIONAL and 144 were intentional. Out of these 440 people, 22 had major adverse outcomes, and 7 died. Confession time: my own daughter was one of the 37 children. Climbed up on my counter, into the medicine cabinet, open the childproof bottle (at age 2) and put some in her mouth. When I caught her, there were pills in the sink with the orange coating missing, but I didn't know if she took any. I called my pediatrician to let her know we were on the way to the ER. She called poison control, and forwarded the info to the ER. When we got there, they gave her liquid charcoal (that was a fight), checked on her after an hour, and sent us home. They didn't believe me that she needed to be admitted...they said poison control confirmed she could go home. I monitored her all night, and when the pediatrician called the next morning, she was very surprised to find us home. Then she was livid when she found out we were sent home against her advice because poison control HAD told them to admit her. (because of the often delayed onset of symptoms).
You are doing a great job by becoming as educated about MAO's as you can, because many people don't know what to do. Once your husband finds out how good life is on it, he will then become interested in the diet...but not yet. Oh...by the way, the pills she took were very bitter inside, and most likely sucked off the candy coating and then spit them out. Luckily it worked out, but the more knowledgeable you are, the better. Jennifer> Dianne,
>
> I had the same fears about Parnate the first time it was suggested to me (about a year-and-a-half ago). No one tried to persuade me to try them, it was just an idea that was floated. At any rate, after responding to an MAOI, I am so happy that I tried it, and I am not at all bothered by the dietary restrictions. It's a more than equitable trade.
>
> I also had tried just about every class of drug under the sun except an MAOI with little success. It's worth it for him to try. Try to make him see that.
>
> I think I remember reading that Parnate is not a particularly lethal drug in overdose, unlike the TCAs, for instance. Also, it's not all that easy to actually kill yourself by eating the wrong foods while on an MAOI. Actual deaths caused by tyramine-related hypertensive crises are very rare. Not to be morbid, but if I was really serious about killing myself, I'd try something else. Probably all I'd get out Parnate + a pound of Stilton cheese is many hours of truly unpleasant illness. Parnate in combination with some medications might be a more serious concern. Perhaps a partial solution would be to put those medications someplace safe and out of reach.
>
> But, really, if your husband is in that much of a risk for suicide, I might think seriously about getting him into a hospital. Perhaps he could start Parnate there.
>
> > Ugh! These last couple of posts have made me very sad. I know I have to share this information
> > with my husband and I fear it will mean he won't try Parnate. He doesn't believe it will help his
> > depression (b/c he has tried SO many other meds. that have not helped), so he sees these restrictions
> > and precautions as very extreme for no benefit. Obviously, he would feel differently if the Parnate
> > helped, but he can't even imagine it helping in his current state of mind. The Parnate also scares me
> > because if it does not help, it seems like it will be giving a person with pretty strong suicidal ideations
> > as very easy means of hurting himself. I'm not sure what I am asking here. I'm just feeling
> > scared and uncertain of how to proceed. I realize in the end these decisions lie with him, but
> > he seems to really be at the end of his rope and not able to make good choices for himself.
> > Thanks for listening.
> > -Diane
Posted by Diane E. on June 15, 2000, at 13:38:56
In reply to Re: MAO/ beer/hops/Med Alert Etc., posted by Jennifer on June 15, 2000, at 0:36:40
Jennifer & Adam:
Thank you both so much. My confidence has been restored. I feel such relief when I hear of people
who did not respond to lots of different medications and did respond to MAOIs. Last night my
husband agreed to give Parnate a try for 6 weeks. I assured him I would not pressure him to stay on it
if it didn't seem to be working. I am quite certain that these dietary restrictions will seem worthwhile if
the medication is effective.Thank you also for the reassurances about the suicide risk. I was not worrying about over-dosing as
much as purposefully eating forbidden foods. But, it sounds like this would be an unlikely route. He is
not actively suicidal. I just know he thinks about it a fair amount (and has for years) and I was worrying
about putting too easy a means in his hands. But, it seems clear that eating a bunch of pepperoni is not
an easy means of suicide for an MAOI user.Thanks again. I have really been needing some hope!
-Diane
Posted by Adam on June 15, 2000, at 18:02:09
In reply to Thank you, posted by Diane E. on June 15, 2000, at 13:38:56
Your welcome, Diane.
Just as a caveat, to make me sleep better at night, I don't want to give the impression
that an overdose of Parnate or a severe "cheese" reaction CAN'T be lethal, just that
it's more likely you will just get very sick from such things. Like I said, some of the
older TCAs are far more poisonous in overdose, and yet they are still prescribed to very
depressed people. One strategy doctors sometimes use is to give out only small amounts
of the drug at a time, if the risk of suicide is severe. I think the chance that, say,
a week's worth of Parnate could, by itself, be taken all at once with lethal results is
quite small. I read an account where a man consumed 400mg of Parnate all at once and
recovered completely. The risk of lethal overdose from Parnate is still quite high
compared to some other antidepressants, but those other antidepressants have virtually
no lethality in overdose.Again, this is not to scare you off, just to make sure we're clear.
> Jennifer & Adam:
>
> Thank you both so much. My confidence has been restored. I feel such relief when I hear of people
> who did not respond to lots of different medications and did respond to MAOIs. Last night my
> husband agreed to give Parnate a try for 6 weeks. I assured him I would not pressure him to stay on it
> if it didn't seem to be working. I am quite certain that these dietary restrictions will seem worthwhile if
> the medication is effective.
>
> Thank you also for the reassurances about the suicide risk. I was not worrying about over-dosing as
> much as purposefully eating forbidden foods. But, it sounds like this would be an unlikely route. He is
> not actively suicidal. I just know he thinks about it a fair amount (and has for years) and I was worrying
> about putting too easy a means in his hands. But, it seems clear that eating a bunch of pepperoni is not
> an easy means of suicide for an MAOI user.
>
> Thanks again. I have really been needing some hope!
> -Diane
Posted by brian on June 15, 2000, at 18:37:28
In reply to MAOIs and beer (Adam?), posted by Diane E. on June 12, 2000, at 16:30:07
> I have been reading old posts about MAOI food restrictions and diet. I would like to know more about people's
> experiences/information about various types of beer and MAOIs.
> In different places I have read:
> domestic may be okay, but imported is not
> bottled may be okay, but tap is not
> only beers "known to be safe" are okay
>
> What are people's experiences with these rules? Does domestic literally refer to country of origin or does
> it really refer to American style lager (e.g., Coors, Bud)? In other words, would American micro-brews fall
> into the domestic or imported category? How would one "know" a beer to be safe? Is there an ingredient or
> brewing process that makes some more likely to be problematic than others?
>
> Adam....I remember reading a while back that you were a lover of good beer and about to start oral MAOIs.
> How is it going? What have you learned?
>
> Fear not, I realize that no one can promise me anything and that the safest bet is to avoid beer all together. I
> am just trying to get a better understanding these distinctions.
>
> Thanks for any input.
> DianeDiane,
It sounds as though others here have answered your question. I don't know about MAOI interactions, but to answer your original question about beer:
Domestic beer is made out of any or all of the following ingredients:
Water
Barley malt (all beer contains some)
Wheat (malted or unmalted)
Rice (like Bud)
Corn (like Michelob)
Hops (usually a very small amount)
Brewing salts (like calcium sulfate, calcium carbonate, NACL, etc.)Domestic beer refers to the big breweries - Bud, Miller, Coors, etc. Domestic beers are heavily filtered to remove yeast and other floating matter, as well as most of the flavor. Sometimes, clarifying agents are introduced to help settle debris. These might include Irish moss (seaweed, active ingredient carrageenan), isinsglass (pulverized fish bladders(!)), gelatin, or Polyclar (a polymer).
Microbreweries are by definition smaller than domestic breweries, and they tend to be much more experimental with their ingredients. Depending on what you try, you may run into fruits, vegetables, coffee, chocolate, ginger, anise, cinnamon, hot pepper, liquor. There's even a type of Irish stout that calls for oysters, and an 18th Century American beer that calls for a chicken! Neither of these last two is around much today (except in the garage closet of the odd Home Brewer ;-)
Also, Microbreweries often use a higher content of hops, both for its bittering qualities (alpha/beta acids in hop resin) and aroma/flavoring (essential oils). Micros also often don't filter like the big boys do, to keep in certain flavors. Unfiltered beer is a bit less stable than filtered, which affects the shelf life. It can also mean that the beer may change in flavor over time, or become more potent due to continued fermentation by the suspended yeast. You might find minute amounts of bacteria (no known pathogens can survive in beer) wild yeast and yeast sediment (high in vitamin B).
Depending on style, you'll have various amounts of esters, aldehydes, diacetyl, fusel alcohols and organic acids. On top of that you've got minerals, ethyl alcohol and CO2.
Many imported beers are similarly brewed, though some, such as Corona and Heineken, are brewed more like Bud and Coors.
Hopefully, someone more knowledgeable about the various effects of these ingredients on MAOIs can further help your husband along in any future beer selection.
Posted by Diane E. on June 16, 2000, at 10:08:49
In reply to Re: Thank you » Diane E., posted by Adam on June 15, 2000, at 18:02:09
Adam,
You need not worry. I did not read your reassurances as meaning that there were no risks. I just took
them to mean that the risks were not quite what I had thought they were. I understand that Parnate is a
riskier drug than some, but it seems that these risks may be worthwhile given my husband's symptoms .
He sees his pdoc today and should be starting the Parnate soon (I assume there will be a wash-out
period for some or all of the seven meds. he takes now).
Thanks for all the information and understanding.
Sleep well.
-Diane
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