MAOI Tyramine Checker
Check Your Food Safety
Enter a food item to see if it's safe for MAOI users. Tyramine can cause dangerous blood pressure spikes.
Common Tyramine Sources
These foods contain high levels of tyramine and should be avoided while on MAOIs:
Note: Even small amounts of these foods can trigger dangerous blood pressure spikes.
When you’re on MAOIs for depression, the biggest danger isn’t the medication itself-it’s what’s on your plate. Most people know to avoid aged cheese. But what about the miso soup you ordered for lunch? The soy sauce drizzled over your stir-fry? The pickled kimchi on the side? These aren’t just harmless condiments. They’re silent triggers that can spike your blood pressure to dangerous levels-fast.
Why Tyramine Is a Silent Threat
MAOIs work by blocking an enzyme that breaks down mood-lifting chemicals like serotonin and norepinephrine. But that same enzyme also clears tyramine, a naturally occurring compound formed when proteins break down during fermentation or aging. When you take an MAOI, tyramine builds up in your bloodstream. Without the enzyme to clean it up, it causes your blood vessels to constrict, sending systolic pressure soaring-sometimes past 180 mmHg. That’s not just a headache. It’s a hypertensive crisis. Stroke. Heart attack. Emergency room. And it can happen within 30 to 60 minutes after eating.It’s Not Just Cheese
Cheese gets all the attention. But it’s just the tip of the iceberg. Here’s what else carries real risk:- Dry-aged salami: 95-115 mg/kg tyramine
- Pepperoni: 80-100 mg/kg
- Smoked fish: 75-90 mg/kg
- Miso paste: 60-85 mg/kg
- Soy sauce: 45-70 mg/kg
- Sauerkraut: 50-75 mg/kg
- Kimchi: 40-65 mg/kg
- Worcestershire sauce: 25-45 mg/kg
- Fish sauce: 35-55 mg/kg
- Marmite or Vegemite: 40-60 mg/kg
- Draft beer: 15-30 mg/L
- Red wine: 20-40 mg/L
- Sherry: 35-55 mg/L
These aren’t outliers. These are everyday foods. And they’re not always labeled. A 2023 study found that 7 out of 10 chain restaurants couldn’t tell you if their menu items contained soy sauce or Worcestershire sauce-even when directly asked.
What About Soy? It’s Complicated
Soy products are a gray zone. Miso, tempeh, and soy sauce are fermented and packed with tyramine. But some doctors say small amounts of soy sauce-like a tablespoon-are okay for certain patients. Others say any fermented soy is off-limits. Why the split? Because individual sensitivity varies wildly. One person might eat a bowl of miso soup and feel fine. Another ends up in the ER. There’s no blood test to predict who’s at higher risk. So the safest rule? Avoid it all. Until you’ve talked to your prescriber-and even then, proceed with extreme caution.
Refrigeration Doesn’t Fix It
You might think keeping food cold stops tyramine from forming. It doesn’t. Refrigeration slows down the process-but it doesn’t reverse what’s already there. In fact, a 2022 Harvard study showed that tofu, which starts at just 5 mg/kg tyramine when fresh, can climb to 25 mg/kg after three days in the fridge. That’s a fivefold increase. And it’s not just tofu. Leftover fermented vegetables, pickled beets, even canned beans stored too long can become risky. The rule? When in doubt, throw it out. If it’s been sitting past its prime, even if it looks fine, it’s not worth the risk.Hidden Sources Are the Biggest Trap
The most dangerous foods aren’t the obvious ones. They’re the ones you don’t think about:- Tomato paste: 20-35 mg/kg. Used in sauces, soups, stews.
- Concentrated yeast extracts: Marmite, Vegemite, even some bouillon cubes.
- Overripe bananas: Tyramine builds as fruit ages. A banana with brown spots isn’t just sweet-it’s risky.
- Leftover meats: Especially cured or smoked. A slice of leftover ham from the fridge? Could be loaded.
- Restaurant meals: Sauces, marinades, dressings-often made with soy sauce, fish sauce, or Worcestershire. No one tells you.
One patient on Reddit shared how she ended up in the ER after eating miso soup at a Japanese restaurant. Her blood pressure hit 210/115. She didn’t know miso was fermented. The server didn’t know either.
How to Eat Safely
You don’t have to give up flavor. You just need to be smarter.- Read labels. Look for words like: fermented, aged, cured, smoked, pickled, yeast extract.
- Ask questions. At restaurants, say: “Does this dish contain soy sauce, fish sauce, miso, or Worcestershire?” If they hesitate, pick something else.
- Stick to fresh. Fresh meat, fresh fish, fresh vegetables. If it’s been sitting, it’s suspect.
- Use MAOI-safe alternatives. Try coconut aminos instead of soy sauce. Use fresh herbs and citrus for flavor instead of bottled sauces.
- Carry a warning card. Emergency rooms see hundreds of hypertensive crises every year. Most doctors don’t know about MAOIs. A printed card saying “I’m on MAOIs-avoid tyramine-rich foods” can save your life.
What About Newer Options?
There’s hope on the horizon. The FDA approved a new enzyme supplement called TyraZyme in 2023 that reduces tyramine absorption by nearly 60% in clinical trials. It’s not a free pass-but it might give some people breathing room. Also, the selegiline skin patch (Emsam) allows small amounts of tyramine at lower doses, making it easier to manage. And researchers are now testing genetic tests to find people whose bodies naturally break down tyramine better. That could lead to personalized diets in the future.But right now? The safest approach is still the oldest one: avoid the known triggers. The research is clear. The risks are real. And the consequences are life-threatening.
Why This Matters More Than Ever
MAOIs are seeing a quiet comeback. They’re one of the most effective treatments for treatment-resistant depression-helping 65-70% of patients where SSRIs fail. But nearly 12.4% of people stop taking them because the diet is too hard. That’s not just a personal loss. It’s a public health issue. Many doctors still don’t know the full list of tyramine sources. A 2022 JAMA study found that only 44% of primary care physicians could name three non-cheese foods to avoid.You’re not alone. There are over 1.2 million Americans on MAOIs. And there’s a growing community-over 12,000 members on the MAOI Support Network’s Facebook group-sharing tips, safe recipes, and restaurant hacks. They’ve learned the hard way. You don’t have to.
Final Rule: When in Doubt, Skip It
There’s no middle ground here. One bite of the wrong food can trigger a crisis. You don’t need to be perfect. But you do need to be careful. Every time. Always. Even if you’ve been on MAOIs for years. Even if you’ve eaten soy sauce before and felt fine. Your body changes. Your sensitivity changes. The food changes. The risk doesn’t.MAOIs can change your life. But only if you protect yourself from the hidden dangers on your plate. Know your food. Know your risks. And never assume something is safe just because it’s not cheese.
Can I eat soy sauce if I’m on MAOIs?
No, it’s not safe. Soy sauce contains 45-70 mg/kg of tyramine, which can trigger a dangerous blood pressure spike. Even small amounts can be risky. Some doctors say a teaspoon might be okay for certain patients, but there’s no way to predict who’s safe. The safest choice is to avoid it completely. Use coconut aminos as a substitute.
Is kimchi dangerous on MAOIs?
Yes. Kimchi is fermented cabbage, and it contains 40-65 mg/kg of tyramine. That’s comparable to aged cheese. Even if it’s store-bought and refrigerated, the tyramine is already formed. Don’t risk it. Swap it with fresh, raw cabbage or cucumber salad.
What about pickled vegetables?
Pickled beets, sauerkraut, and other fermented vegetables are high in tyramine. Sauerkraut has 50-75 mg/kg. Pickled beets have 30-55 mg/kg. Refrigeration doesn’t remove the tyramine-it just slows more from forming. Avoid all pickled or fermented vegetables unless they’re freshly made and eaten immediately.
Can I drink beer on MAOIs?
Draft beer is risky-15-30 mg/L of tyramine. Bottled beer is safer, but still not risk-free. The longer beer sits, especially if unpasteurized, the more tyramine builds. Some people report issues even with light bottled beer. The safest approach is to avoid all alcohol while on MAOIs. If you must drink, talk to your doctor first.
What should I do if I accidentally eat something high in tyramine?
Monitor your symptoms closely. Headache, stiff neck, rapid heartbeat, sweating, nausea, or blurred vision could mean your blood pressure is rising. If you feel any of these, check your blood pressure if you can. If it’s over 160/100, go to the ER immediately. Don’t wait. Carry a warning card and tell medical staff you’re on an MAOI. They need to know to avoid certain medications like decongestants or stimulants.
How long do I need to avoid tyramine after stopping MAOIs?
At least 14 days after your last dose. The enzyme that breaks down tyramine takes time to recover. Some doctors recommend waiting up to 3 weeks, especially if you were on a high dose. Don’t assume it’s safe just because you stopped the pill. The risk doesn’t disappear overnight.
Are there any safe fermented foods?
Yes-but only if they’re fresh and not aged. Yogurt made with live cultures is generally safe because it’s not fermented long enough to build tyramine. Fresh, unaged cottage cheese and ricotta are okay. Kefir is usually safe if it’s not fermented for more than 48 hours. Always check the label: if it says “aged,” “fermented,” or “cultured for weeks,” avoid it.
Can I eat bananas on MAOIs?
Only if they’re yellow and firm. Overripe bananas with brown spots contain higher tyramine levels. A single ripe banana is usually fine, but if you’ve had a reaction before, avoid them entirely. When in doubt, skip it.
Why don’t more doctors warn patients about this?
Many doctors were never trained on the full list of tyramine sources. Most still think cheese is the only danger. A 2022 study found that less than half of primary care doctors could name three non-cheese foods to avoid. The information is out there, but it’s not being passed on. That’s why patients need to educate themselves and bring printed guidelines to their appointments.
Is there a test to see if I’m sensitive to tyramine?
No. There’s no blood test or genetic screen that can predict how your body will react. Sensitivity varies from person to person. One person might eat miso soup and be fine. Another has a crisis. That’s why the only safe rule is strict avoidance-no exceptions.
Okay but have you heard about the CIA’s 1970s program to weaponize fermented foods? They were testing tyramine as a silent bio-agent because no one checks soy sauce. That’s why the FDA won’t force restaurants to label it-because they don’t want you to know how easy it is to turn a lunch into a cardiac event. I’ve got documents. Want me to DM you the redacted pages? 😏
I’ve been on MAOIs for 8 years and this is the most accurate breakdown I’ve ever read. I switched to coconut aminos after a near-miss with miso ramen-my BP spiked to 178/102 in 20 minutes. Now I make my own broth with fresh ginger and garlic. It’s not the same, but it’s safe. Also, fresh banana = fine. Brown spots = trash. Learned that the hard way.
Wow. So tyramine is the new gluten? Like, everyone’s scared of it but no one can explain why it’s not in the FDA’s top 10 allergens? Also, ‘draft beer’ is risky? Bro, I’ve had 3 IPAs on MAOIs and I’m typing this from my couch. Your ‘science’ is just fear-mongering with a thesaurus.
I’m a nurse and I’ve seen three hypertensive crises from MAOI patients who thought ‘it’s just a little soy sauce.’ One guy ate a bowl of pho and thought the ‘umami’ was just flavor. He ended up in the ICU with a hemorrhagic stroke. The scary part? His doctor didn’t even know fish sauce was on the list. I hand out printed guides to every MAOI patient I see. Don’t trust your taste buds. Don’t trust the server. Don’t trust ‘it’s always been fine.’ Your body changes. The food changes. The risk doesn’t care how long you’ve been on the med.
THIS IS A GOVERNMENT COVER-UP. They don’t want you to know that Big Fermentation (SoyCorp, Kraft, Heinz) is pumping tyramine into your food because it makes you crave MORE. They’re literally engineering addiction. And the FDA? They’re in bed with them. That ‘TyraZyme’ supplement? It’s a placebo. The real cure is quitting MAOIs and going keto. I did it. My depression lifted. My BP is normal. The system wants you dependent on pills AND scared of food. Wake up.