It is well known that the consumption of certain foods triggers migraines in many people. And research has shown that people taking monoamine oxidase inhibitors (MAOIs - commonly used to treat conditions like depression and anxiety) are at increased risk for migraines as well. It turns out that not only are these two situations related, but the common link is also related: diet! Eating foods high in tyramine (and other amines like phenylethylamine) can cause migraines in susceptible individuals. Why is this? To explain, let’s focus on one of the most common triggers: tyramine.
Tyramine is a biogenic monoamine whose main job is to regulate our blood pressure. Monoamines are a class of neurotransmitters that include two you have probably heard of: dopamine and adrenaline. These neurotransmitters affect our brain by influencing mood, agitation, attention and memory. But they also play a vital role in our “fight-or-flight” response through stimulation of our sympathetic nervous system. We all know that adrenaline increases our heart rate, constrict the body’s blood vessels and increases lung capacity. But did you know that it dilates blood vessels in the brain? More on this in a minute.
WHAT IS MAO?
Monoamine oxidase (MAO) is an enzyme in our body that does pretty much what it sounds like: it oxidizes, or breaks down, monoamines. MAO’s job is to keep monoamines in check. So, if we eat too much tyramine (or phenylethylamine), MAO quickly breaks down the excess. This limits the effect that tyramine has on our sympathetic nervous system.
However, certain people are very sensitive to certain monoamines or they have a poor ability to break them down. This is called amine intolerance. (Similarly, patients taking MAOI (monoamine oxidase inhibitors) may also become amine intolerant because their medication blocks MAO from doing its job.) Either scenario leads to an increase in the levels of tyramine circulating in the body.
So, as tyramine builds up, it begins to increase blood pressure. As levels continue to rise, however, it stimulates our sympathetic nervous system. As I mentioned above, this dilates the blood vessels in the brain to the point that a migraine is triggered. And for those that are severely compromised, high levels of circulating tyramine activate the “fight-or-flight” response and can cause a HYPERTENSIVE CRISIS, which is a medical emergency. Symptoms include headaches, nausea, blurred vision and dangerously high blood pressure.
At this point you are probably thinking that we have avoid eating these monoamines at all cost! But, it may surprise you to know that tyramine is very common in much of the food that we eat every day. So where does tyramine come from? Tyramine is the result of the breakdown of tyrosine, a very important amino acid that our body needs to function properly. We can get tyrosine directly from eating certain foods, but our body also makes it out of another amino acid called phenylalanine. (Phenylethylamine is created from the breakdown of phenylalanine.)
So, not only do we eat an abundance of tyramine, but we also consume it and make the precursors to it! As we mentioned, the body usually deals with this excess by breaking it down quickly and excreting it. But for those are amine intolerant, it can be difficult to control the levels of tyramine in their diet.
FOODS TO AVOID
Many foods are rich in tyramine, especially tyrosine-rich foods that are aged, aging, or spoiled. (Because, as we mentioned, tyramine comes from the break-down to tyrosine!) Here are some examples of high-tyramine foods to avoid:
CHEESE: Aged cheese like parmesan, cheddar, bleu cheeses, provolone, mozzarella, and Camembert.
CURED, SMOKED & PROCESSED MEATS: Sausages, hot dogs, pepperoni, salami, bacon, smoked fish
CACAO: including chocolate and cacao
PICKLED & FERMENTED FOODS: sauerkraut, tofu, pickles, kimchi,
SOY: miso, tofu and even soybeans
SAUCES: especially fermented varieties like miso, soy and teriyaki sauces
CITRUS: avoid or limit
DRIED OR OVERRIPE FRUIT: raisins, prunes, or ripe bananas, papayas, passion fruit and avocados
YEAST: sourdough bread, Marmite, brewer’s yeast, nutritional yeast, beer (especially tap)
ALCOHOL: red wine, sherry
LEFTOVERS: improperly stored or food past freshness dates; this can include ground meats, old veggies and fruit, and stale breads!
BEANS: certain varieties like broad and fava beans
NUTS AND SEEDS: most sources agree to avoid nuts and seeds!
MSG: other sources of free glutamic acid include TVP, hydrolyzed proteins, and yeast extract (this may include whey protein supplements!)
ASPARTAME (Equal, NutraSweet)
CHOCOLATE: if phenylethylamine sensitive
RECOMMENDED FOOD CHOICES
While these recommendations are generally accepted as safe, each individual reacts differently so care must be taken to read food labels and inspect the food for any signs of spoilage.
FRESH CHEESES: Cottage cheese, yogurt (though there is conflicting information on this), farmer’s cheese
FRESH MEAT: poultry, beef, eggs and fish. Must not be allowed to age or spoil.
BEANS: other fresh or canned beans
VEGGIES: fresh vegetables with any signs of spoilage removed
GRAINS: most breads, grains and pasta are considered low in tyramine
CREATING A LOW-TYRAMINE OR TYRAMINE-FREE DIET
It may seem daunting to try to piece together a food plan while avoiding all of the banned foods! But, whether you are amino intolerant or are taking an MAOI, a healthy and tasty diet is not impossible. I recommend keeping a food diary along with a diary of any side effects including headaches, dizziness or nausea. Together, we can work on eliminating your trigger foods as well as re-introducing safe foods to help you gain control over your migraines.
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Also, at LKN private nutrition services you can learn more about nutrition and disease and how to choose the right foods for YOU.