Foods High in Tyramine

The tyramine content of foods is relevant to two groups of people. The first are those with hypertension, and the second are the ones with migraines.

Many people with migraines or migraineurs may not know that they have migraines, particularly if they don’t have a headache. Not all migraines have headaches. Some will only have auras. This topic is discussed in this article, Migraine Aura Without Headache.

Tyramine, in large quantities, can increase blood pressure to cause hypertension and migraines. The consumption of large amounts of tyramine can release hormones like noradrenaline and adrenaline to elevate the blood pressure.

The most severe cases of tyramine toxicity manifesting as migraine or hypertensive crises are from the consumption of aged cheese.

A hypertensive crisis is a severe increase in blood pressure. The systolic (top number) can increase above 180 mm Hg, and the diastolic (bottom number) can go up to 120 mm Hg or higher. A hypertensive crisis can damage blood vessels and lead to a stroke or brain bleed.

In a study among Austrians, 200 mg is the maximum tolerable amount of tyramine per meal. [1]

A 200 to 800 mg of dietary amine can induce a mild rise in blood pressure.

Where does tyramine come from?

Proteins are made up of amino acids, and tyrosine is one of the amino acids. Tyrosine can be changed by enzymes produced by bacteria and yeasts present in food into tyramine.

The bacteria and yeast can be naturally present or added during food processing, like in cheese manufacturing and beer fermentation. These microorganisms help with food processing and bring out the desired flavor of the products.

Some fruits or vegetables have intrinsically high levels of tyramine.

Cooked foods stored in the refrigerator or left at room temperature for longer than two to three days can have high tyramine. The enzyme activity of some of the germs in the food can continue to produce and accumulate tyramine.

Tyramine levels of food on the Internet can be Inconsistent.

An internet search for tyramine-containing foods can be confusing. Some may list certain foods like garbanzo or chickpeas is high in tyramine, and others may say it has low levels.

Growth conditions can also affect the tyramine content of plants. In general, the more hostile the growing environment, like drought, the higher the tyramine content.

Another reason for the discrepancies could be the sources of their data. If the tyramine tests were conducted decades ago, some foods might show high levels of tyramine.

For a good reason, some changes have been made in food manufacturing, storage, and transport conditions to lower the tyramine content.

The Monoamine-Oxidase Inhibitors

In the 1960s, a class of anti-depressants called monoamine oxidase inhibitors (MAO-Is) was released as a medication for depression. MAO-Is works by increasing monoamines like norepinephrine, serotonin, and dopamine.

Higher monoamines explained how MAO-Is work for depression.

But there was a problem. Many who took the MAO-Is had headaches and hypertensive crises. Some developed strokes and intracranial bleeding. [2]

It turned out; the MAO-Is are also preventing the degradation of tyramine, thus making it accumulate. This tyramine build-up contributes to migraines and hypertensive urgency and their complications.

The identification of the interaction between tyramine and MAO-I interaction led to many changes.

Food manufacturing was adjusted to lower the resulting tyramine content. Many physicians also stopped prescribing MAO-Is.

That is why some tyramine data in processed food made decades ago may not be applicable anymore.

In the list below, some foods like the Brie cheese may have very low or undetectable (ND) tyramine levels, while another study will show a high number. Again, this may be due to differences in brie making like yeast cultures and storage temperatures and packaging.

The foods with the highest tyramine levels are hard cheese like Gouda, Roquefort, Cheddar, and Edam.

Among fish products, fermented fish sauce, soy sauce, salt dried mackerel (galunggong), Dutch cured herring (tamban), salt dried shrimp top the list. Fermented fish sauce and soy sauce are commonly used in Asia. In the Philippines, fermented fish sauce is known as “patis.”

Grapes and watermelon have the highest tyramine content among fruits.

 

 

Note that the tyramine content are listed as milligrams per kilogram. (mg/kg) and the maximum tolerable level of tyramine in a study among Austrians is 200 mg.

The following is a list of foods and their tyramine content from a review by Andersen et al. [3]. A pdf copy of the file is available at this link.

Foods Containing High Tyramine Levels

Tyramine Content of Some Foods

Some foods not included in the list that are also high in tyramine are Kimchi. Kimchi is a Korean dish that is gaining popularity worldwide.  The high tyramine content may be because of the fermented fish sauce and fermented shrimp paste used in kimchi manufacturing. [4]

Take away Message to lower Tyramine Intake.

1. Eat foods with high tyramine content in moderation. Better yet, eat everything in moderation.
2. Remember that fermented foods like kimchi and fish sauce have high levels of tyramine.
3. It is better to store leftover foods in the freezer to stop tyramine formation.
4. A cup (250 ml) of brewed coffee can have 62.5 to 472.5 mg of tyramine.
5. Not everyone will have elevated blood pressure after eating high tyramine-containing foods.
6. The way to know is to have a daily food and blood pressure diary. Include everything in the journal, including the condiments and sauces.  You may be able to establish a pattern about what type of food elevates your blood pressure or causes your migraine.

 

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References:

Photo credit: Fish sauce by Binh Giang (Wikipedia)

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