Tyramine foods; a migraine trigger

### Understanding Tyramine: A Natural Health Perspective

What is Tyramine?

Tyramine is a naturally occurring compound known as a biogenic amine. It is found in certain foods, particularly those that are aged, fermented, or processed. Tyramine plays a role in regulating blood pressure by affecting the release of norepinephrine, a neurotransmitter and hormone that influences the "fight or flight" response. While tyramine is not harmful to most people, some individuals, especially those taking certain medications or with tyramine sensitivity, can experience adverse effects when consuming tyramine-rich foods.

Tyramine is produced from the amino acid tyrosine as proteins in food break down, particularly during the aging or fermentation process. This is why foods like aged cheeses and fermented products tend to have higher tyramine levels.

Tyramine-Rich Foods

Tyramine is most commonly found in foods that have undergone aging, fermentation, or spoilage. Here are some common tyramine-rich foods:

1. Aged and Fermented Foods:

- Aged cheeses: Cheddar, Gouda, blue cheese, Parmesan, Swiss, and feta.

- Fermented foods: Sauerkraut, kimchi, soy sauce, miso, and tempeh.

- Processed meats: Salami, pepperoni, bologna, and other cured or smoked meats.

2. Alcoholic Beverages:

- Red wine: Contains higher levels of tyramine due to fermentation.

- Beer: Especially tap or unpasteurized beer.

- Aged spirits: Whiskey, bourbon, and other aged liquors.

3. Certain Fruits and Vegetables:

- Overripe fruits: Bananas, avocados, and tomatoes that have become overripe or spoiled.

- Fermented vegetables: Sauerkraut and pickles.

4. Soy Products:

- Soy sauce, tofu, miso, and tempeh are particularly high in tyramine due to fermentation.

5. Other Tyramine Sources:

- Yeast-containing products: Marmite, Vegemite, or other yeast extracts.

- Certain fish: Smoked or pickled fish like herring and mackerel.

Symptoms of Tyramine Sensitivity

For most people, tyramine does not cause any issues, and it’s simply broken down by an enzyme in the gut known as monoamine oxidase (MAO). However, when MAO activity is inhibited or reduced—either due to medications or natural sensitivity—the body may have difficulty processing tyramine, which can lead to an excessive release of norepinephrine. This can result in what's commonly known as a "tyramine reaction", where blood pressure spikes and other symptoms may occur.

Common symptoms of tyramine sensitivity or reaction include:

- Headaches or migraines: Tyramine is well-known for triggering migraines in susceptible individuals. People with migraine disorders are often advised to avoid tyramine-rich foods.

- Increased blood pressure: Tyramine causes the release of norepinephrine, which can lead to a rapid increase in blood pressure (called a hypertensive crisis in severe cases).

- Heart palpitations: Irregular or rapid heartbeats may occur after consuming tyramine.

- Sweating and flushing: Some individuals experience sweating, flushing, or feeling hot after eating foods high in tyramine.

- Nausea and vomiting: Digestive upset, including nausea, can occur in response to tyramine.

People who are taking monoamine oxidase inhibitors (MAOIs), a class of medications used for treating depression, Parkinson’s disease, and other conditions, are particularly susceptible to tyramine reactions. These medications block the enzyme that breaks down tyramine, allowing tyramine levels to rise quickly in the body, which can lead to severe blood pressure spikes.

Naturopathic Perspective on Managing Tyramine Sensitivity

For individuals who are sensitive to tyramine, managing tyramine intake is essential to avoiding symptoms. From a naturopathic perspective, addressing tyramine sensitivity involves dietary adjustments, stress management, and supporting overall neurotransmitter balance.

1. Low-Tyramine Diet:

The most straightforward approach to managing tyramine sensitivity is following a low-tyramine diet. This involves reducing or eliminating tyramine-rich foods, especially those that are aged, fermented, or highly processed. Some steps to take include:

- Eat fresh, non-processed foods: Focus on fresh meats, fruits, vegetables, and grains.

- Avoid aged and fermented products: Stay away from aged cheeses, fermented vegetables, and processed meats.

- Limit alcohol consumption: Particularly avoid red wine and aged spirits, as these are high in tyramine.

- Monitor fruit ripeness: Be mindful of consuming overly ripe fruits like bananas and avocados, as tyramine levels increase as these fruits age.

2. Support Gut Health:

Because tyramine is broken down in the gut, supporting optimal gut function may help individuals better tolerate tyramine-rich foods. Naturopathic strategies for gut health include:

- Probiotics: Certain strains of probiotics, such as Lactobacillus and Bifidobacterium, can support gut health and improve digestion, potentially helping with tyramine metabolism.

- Prebiotic fibers: Foods like garlic, onions, and asparagus (if tolerated) can feed beneficial gut bacteria and improve overall digestive function.

- Digestive enzymes: While there isn’t a specific enzyme supplement for tyramine, general digestive enzyme supplements can support overall gut health and digestion.

4. Migraine Prevention:

For individuals whose primary symptom of tyramine sensitivity is migraines, preventing migraines naturally is key:

- Magnesium: This mineral has been shown to help prevent migraines by supporting blood vessel health and reducing muscle tension. Magnesium-rich foods include spinach, almonds, and dark chocolate.

- Riboflavin (Vitamin B2): Riboflavin has been studied for its potential to reduce the frequency of migraines. It's found in foods like eggs, meat, and dairy.

5. Stress Management:

Since tyramine sensitivity can cause an exaggerated release of stress hormones, it’s important to manage stress levels naturally. Practices like yoga, meditation, and deep breathing exercises can help balance the body’s stress response and may reduce the severity of tyramine reactions.

6. Supplementation:

While most individuals with tyramine sensitivity can manage their symptoms with dietary adjustments, some may benefit from specific supplements:

- CoQ10: Coenzyme Q10 has been linked to reduced migraine frequency and better energy metabolism, making it potentially helpful for people sensitive to tyramine-induced migraines.

- N-acetylcysteine (NAC): This powerful antioxidant may support neurotransmitter balance and protect against oxidative stress caused by excess norepinephrine during a tyramine reaction.

Conclusion

Tyramine is a naturally occurring compound found in many aged and fermented foods. While it poses no problem for most people, those with tyramine sensitivity, or individuals taking MAOI medications, may experience adverse reactions such as migraines, high blood pressure, and digestive upset when consuming tyramine-rich foods. Managing tyramine sensitivity from a naturopathic perspective involves adopting a low-tyramine diet, supporting gut and cardiovascular health, and managing stress. By addressing these underlying factors, individuals can often reduce or prevent symptoms and improve overall well-being.

References

1. Gillman, P. K. “Monoamine Oxidase Inhibitors, Tyramine, and Drug Interactions.” Journal of Clinical Psychopharmacology, 2011.

2. Jansen, K. L., & Rogers, P. J. "Tyramine Levels in Common Foods and Beverages: Implications for Diet and MAOI Therapy." Journal of Neural Transmission, 2006.

3. Friedman, A. M. “Migraine and the Tyramine Connection.” Headache: The Journal of Head and Face Pain, 2008.

4. Collins, G. G., & Sandler, M. "Tyramine, Hypertension, and Diet: What Are the Implications for the Treatment of Depression?" Journal of Neurochemistry, 2010.