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Tyramine in food: the MAOI diet, and the myths still attached to it

Tyramine is a pressor amine: it displaces noradrenaline from nerve endings and raises blood pressure. Normally the enzyme monoamine oxidase destroys it in the gut wall and liver before it gets anywhere. Block that enzyme with a drug and the same plate of food becomes a genuine cardiovascular event — which is why the tyramine diet exists at all.

This page is general information and not a diagnosis or a prescription. If you take a monoamine oxidase inhibitor, the diet sheet that applies to you is the one from your prescriber or pharmacist for your specific drug and dose — the restrictions differ sharply between irreversible non-selective MAOIs, reversible inhibitors and low-dose transdermal selegiline. Never stop, change or reduce a prescribed medicine because of a web page. A sudden severe headache with a spike in blood pressure while on an MAOI needs emergency care.

The “cheese reaction”, and why it was called that

When the first monoamine oxidase inhibitors were introduced as antidepressants in the late 1950s, a pattern of sudden severe headaches and hypertensive episodes appeared in patients taking them. A hospital pharmacist noticed his wife’s attacks followed cheese, and the mechanism was worked out from there: matured cheese is rich in tyramine, monoamine oxidase is what normally destroys dietary tyramine, and the drug had removed that defence.

The result was decades of very long avoid-lists, many of them copied from one another and expanded on suspicion rather than measurement. Modern lists are far shorter, because the foods have actually been analysed. The principle that survived is simple and biochemical: tyramine accumulates where protein has been broken down by microbes or by time. Fresh food is not a tyramine problem; aged, cured, fermented and spoiled food is.

What is genuinely restricted, and what was dropped

The foods that stayed on the list are matured cheeses, air-dried and fermented sausages and other cured meats, fermented soy products including soy sauce and miso, sauerkraut and similar fermented vegetables, yeast extract spreads and brewer’s yeast, and draught or home-brewed beer, which unlike pasteurised bottled beer is still biologically active. Broad bean pods are on the list for a different reason: they contain dopa rather than tyramine, and dopa also matters on an MAOI.

Anything that has been stored too long or is beginning to spoil belongs on the list regardless of what it is — a fish or a piece of meat that has sat too long is the same problem as an aged cheese.

What was dropped is almost as important. Chocolate, bananas, avocado, yoghurt, fresh cheeses such as cottage cheese and mozzarella, and pasteurised bottled beer in ordinary amounts do not carry enough tyramine to matter for most people, and they appear on old sheets because they were guessed at rather than analysed. Banana peel is a real source; banana flesh is not.

Migraine and tyramine: a much weaker story

Tyramine has been proposed as a dietary migraine trigger since the 1960s, and it appears on almost every migraine trigger list in circulation. The evidence behind it is far weaker than the MAOI interaction: provocation studies have been inconsistent, and the foods most often blamed — chocolate, cheese, red wine — are also foods people crave during the prodromal phase, hours before the headache starts, which makes the trigger and the early symptom very hard to tell apart.

Headache guidelines therefore do not recommend blanket dietary elimination for migraine. The recommended approach is to identify an individual’s own reproducible triggers with a headache diary, and to prioritise the factors with much better evidence: sleep regularity, meal regularity, hydration, and caffeine and medication-overuse patterns.

Tyramine by food group

Bands, not decimals. Where a published quantity for a specific food could not be verified against a document, this surface prints the band rather than a number — and every food below links to its own nutrition page so you can see what else is in it.

What changes the number

• Ageing is the whole variable: the same cheese at three months and at eighteen months is not the same food here.
• Spoilage produces tyramine in anything protein-rich, which is why “eat it fresh” is the core of the diet sheet.
• Pasteurisation and filtration matter for beer — bottled and pasteurised is different from draught and unfiltered.
• The restriction depends on the drug: reversible and selective inhibitors, and low-dose transdermal selegiline, carry much lighter or no dietary restriction. Only your prescriber can say which applies.
• Freezing does not remove tyramine that has already formed, but it does stop more from forming.

Where else these foods are flagged

Foods raised on this page that also sit in a raised band on at least two of the other fifteen. Reassuring bands are not counted, so a row here means the food genuinely collects labels rather than merely getting mentioned a lot.

It is worth reading before removing anything. The lists on this surface were each written for a different person with a different problem, and they converge on the same small group of nutrient-dense foods. Satisfying all of them at once produces a diet nobody designed and nobody has tested.

Talking to someone who can actually test

Nothing on this surface is personal medical advice. If a food genuinely makes you ill, if you have had a kidney stone or a gout attack, or if you are considering removing a food group from your diet, the person to talk to is your doctor, pharmacist or a registered dietitian — they can test for the things that can be tested for, which a table cannot.

Sources: Product information and prescriber diet sheets for individual monoamine oxidase inhibitors — the only authority on which restriction applies to which drug. · Analytical surveys of tyramine content in aged cheese, cured meat and fermented foods, which are the basis for the shortened modern lists. · Headache society guidance on dietary triggers in migraine, which favours individual diaries over blanket elimination. · Food names and links: the site food database. Checked 2026-09-06.

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