Tyramine Intolerance – underlying cause of migraine headaches?

Tyrosine combines with other amino acids to form proteins, and just like the amino acid histadine breaks down to histamine (see this previous article on Histamine Intolerance), tyrosine breaks down to form tyramine.

Normally, the excess tyramine is broken down by the enzyme monoamine oxidases (MAO) — in the same way that excess histamine is broken down by the enzyme diamine oxidase (DAO).  In individuals that take certain types of medications such as MAO inhibitors (used in treating some types of depression) and certain medications used for treating Parkinson’s disease, levels of tyramine will build up in the body because the enzyme that breaks it down is inhibited.

In those who have insufficient amounts of the enzyme monoamine oxidase, levels of tyramine can also build up and this is called Tyramine Intolerance [1].

Symptoms of Tyramine Intolerance

The body naturally responds to the presence of tyramine by making catecholamines such as epinephrine and norepinephrine which are neurotransmitters involved in the “fight or flight” response. If tyramine accumulates, too much of these chemicals are released, which leads to an increase in blood pressure and heart rate [2]. If these chemicals go high enough (such as is the case with those taking certain medications) this can lead to a very rapid and dangerous increase in blood pressure called a ‘hypertensive emergency’ which can result in bleeding in the brain (hemorrhagic stroke)[3] and rarely, even death.  At very least, the very high blood pressure can cause damage the body’s tissues and organs.

Those with a reduced ability to clear tyramine due to Tyramine Intolerance may experience migraine, heart palpitations or GI issues, including nausea and vomiting [2].

Tyramine Intolerance Diet

In those taking MAO Inhibitor medication or specific medications for treating Parkinson’s disease,  a tyramine-free diet is prescribed. Since the adverse effects of eating tyramine-containing foods can be so serious, strict adherence is needed.

For those with diagnosed Tyramine Intolerance, a low tyramine diet will be recommended and for those with suspected Tyramine Intolerance a low tyramine diet may be trialed to see if symptoms improve. This is especially the case in people who experience migraine— as it has long been thought that tyramine may underlie the constriction of blood vessels that increases blood pressure associated with migraine[4].

Low Tyramine Diet — not as easy as following a ‘list’

Tyramine naturally occurs in small amounts in protein-containing foods, but as foods age, mature or ripen, tyramine levels increase.

Avoiding strong or aged cheeses, cured, smoked or processed meats, pickled, cultured or fermented foods (including many Asian condiments), nuts and nut butters and some seeds and seed butters, aged spreads such as Marmite and Vegemite, and alcoholic beverages [3,5] is a good place to ‘start’, however reducing tyramine in the diet isn’t as straight forward as simply following a “list’.

Knowing which cheeses, for instance have high levels of tyramine and which have moderate levels can be looked up, but as with Histamine Intolerance one needs to learn how to select, store and prepare foods in order to minimize their amine content.

As importantly, some tyramine-containing foods may act as a trigger to migraine in one person, but not in another so it is often unnecessary to restrict all tyramine-containing foods. As well, symptoms can occur after as little as 20 minutes and others as long as 2 hours and since I think its preferable to only restrict the foods that are causing symptoms, this is where my use of a Time-Food-Time-Symptom journal used in the Food Sensitivity / Food Allergy Package can be extremely helpful.  It enables me to determine which foods are contributing to symptoms, so only they are eliminated and it doesn’t require people to keep exhaustive (and exhausting!) “food diaries”.

More Info?

If you have been diagnosed with Tyramine Intolerance or suspect you may be sensitive to tyramine, I can help.

You can learn more about the Food Sensitivity / Food Allergy Package by clicking here and if you would like additional information, please send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

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References

  1. Joneja, J. Histamine and tyramine sensitivity – how closely are they linked? Food Matters, October 2017, https://www.histamine-sensitivity.com/histamine-tyramine-similaraties-10-12.html
  2. Van Eaton J. Tyramine-Free Diets. Healthline, Feb 1, 2019, https://www.healthline.com/health/tyramine-free-diets
  3. Hall-Flavin D. Mayo Clinic, MAOIs and diet: Is it necessary to restrict tyramine? https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/maois/faq-20058035
  4. Costa MR, Glória MBA. Migraine and Diet, Encyclopedia of Food Sciences and Nutrition (Second Edition), 2003, https://www.sciencedirect.com/science/article/pii/B012227055X007835
  5. Skypala IJ, Williams M, Reeves L, Meyer R, Venter C. Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence. Clin Transl Allergy. 2015;5:34. Published 2015 Oct 13. doi:10.1186/s13601-015-0078-3

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