Updated recommendations on dietary restrictions with MAOIs
from the medical literature (thanks to PubMed)

Kevin Black, M.D.
(if you're not my patient, please discuss this with your own doctor)

No aged, hard cheeses
No air-dried sausages, cured hams, etc.
No sauerkraut
No soy sauce
Red wine, tap beer only in very limited quantities
No Fava beans (broad beans), Chinese pea pods, etc.
No aged chicken liver
No meat that could be spoiled
No Marmite yeast extract

No medications including over-the-counter medications without notifying me or telling your doctor you are taking an MAO inhibitor.

Eat anything else you want in reasonable quantities -- assuming it is a normal food (e.g., no banana peels!).

1: J Clin Psychopharmacol 1996 Oct;16(5):383-8
Comment in:
     J Clin Psychopharmacol. 1997 Jun;17(3):226-7; discussion 227-8.
     J Clin Psychopharmacol. 1997 Jun;17(3):227; discussion 227-8.
Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets.
Walker SE, Shulman KI, Tailor SA, Gardner D.
Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.

Traditional monoamine oxidase inhibitors (MAOIs) remain an important class of drugs for a variety of psychiatric conditions, including depressive illnesses, anxiety, and eating disorders. It was the objective of this study to refine the MAOI diet by determining the tyramine content of a variety of untested and "controversial" foods that continue to appear on MAOI diet-restricted food lists. A secondary objective of the study was to evaluate the effect of freshness on the tyramine content of some foods. Fifty-one food samples were evaluated for tyramine content by liquid chromatography. Food samples included a selection of sausages, beverages, sliced meat products, including chicken liver, and some fruits, including raspberries, bananas, and banana peels. Foods that were found to have dangerously high concentrations of tyramine (> or = 6 mg/serving) included chicken liver aged 9 days (63.84 mg/30 g), air-dried sausage (7.56 g/30 g), soy sauce (0.941 mg/ml), and sauerkraut (7.75 mg/250 g). Of the foods analyzed in this study, only those with high tyramine content per serving should continue to be absolutely restricted. All other foods are either safe for consumption or safe in moderation. The data provided should be combined with the data from other similar analytical studies to develop a list of foods that should be absolutely restricted. A more accurate list of restricted foods may enhance patient dietary compliance.
                       PMID: 8889911

2: J Clin Psychiatry 1996 Mar;57(3):99-104
Comment in:
     J Clin Psychiatry. 2000 Feb;61(2):145-6.
The making of a user friendly MAOI diet.
Gardner DM, Shulman KI, Walker SE, Tailor SA.
Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.

BACKGROUND: Many monoamine oxidase inhibitor (MAOI) diets are considered to be excessively restrictive and founded on poor scientific evidence. We present a safe and practical MAOI diet based on the related clinical and analytic data. METHOD: We used a critical review of the literature and our own tyramine assay results to categorize foods to be restricted absolutely, taken in moderation only, or unrestricted. RESULTS: We recommend that users avoid aged cheese; aged or cured meats (e.g., air-dried sausage); any potentially spoiled meat, poultry, or fish; broad (fava) bean pods; Marmite concentrated yeast extract; sauerkraut; soy sauce and soy bean condiments; and tap beer. Wine and domestic bottled or canned beer are considered safe when consumed in moderation. Other foods not mentioned are considered unrestricted. CONCLUSION: The concerns about perpetuating an overly restrictive MAOI diet include the avoidance by prescribers of a potentially useful treatment option, excessive limitations on lifestyle for patients, and increased risk to patients secondary to noncompliance with the diet. We propose an MAOI diet that has a solid scientific and clinical basis and that is, above all, practical.
                       PMID: 8617704