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The MAOI Patch and the Tyramine Diet

When MAOI Inhibitors were introduced as the first antidepressants in the early 50’s, they came in pill form. The pills were processed in part by the liver and this caused severe side effects in people who had ingested food containing Tyramine.

The Food and Drug Administration pulled MAOIs from the market until they figured out what was going on. Later the FDA relented, so long as people were warned not to eat aged cheese, processed meats, draft beer, and a host of other common foods.

emsamIn 2006, a new delivery system was released, an MAOI patch called Emsam. This enabled the drug to bypass the liver on the way to the brain. Clinical trials of the 6 MG patch found no food interaction. Unfortunately, it usually takes a higher dose to achieve the antidepressant effect.

In a rush to market, the makers of the Emsam patch did not seek FDA approval for higher doses, so a patch for greater than 6 MG carries dire warnings about ingesting foods laden with Tyramine.

I wore a 12 MG (i.e., over the limit) patch during a recent two-week trip through Alsace, Bavaria, and Hungary during which I stuffed myself with smelly cheese, tap beer, cured pork, sauerkraut, goulash, foie gras, and other Tyramine-rich foods.









I’ve had no reaction at all. None. I’m not going to pay attention to the diet restrictions.

Mylan, the manufacturer of the Emsam patch, should run trials with patches stronger than 6 MG. The current guidelines unnecessarily restrict the dining pleasure of people on higher doses.

Your mileage may vary.

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Tyramine Diet

Ah, the joys of modern medicine.

I’ve begun taking a drug that requires me to restrict my diet severely. I’m not allowed to eat aged cheese, sausage, draft beer, sourdough bread, or anything else that contains significant amounts of tyramine, an amino acid that helps regulate blood pressure.

Eating the forbidden fruit can cause severe headache, nausea, stiff neck, vomiting, a fast or slow heartbeat, tight chest pain, a lot of sweating, confusion, dilated pupils, and sensitivity to light. People have died after bingeing on cheese.

So many foods are restricted (sauerkraut, bacon, caviar, peanuts, vermouth!) that I need a way to remind myself of what to avoid. I hope visualization can prop up my memory.

If pictures aren’t your thing, here’s a good list from the National Headache Foundation. (Tyramine can cause migraine headaches in people who are sensitive to it.)

Foods to Avoid on a Tyramine-Restricted Diet

krautcaviar fish4 fish3 fish2 fish herring duckliver2 duckliver cornedbeef bacon hotdog sausage3 choucroute sausage2 sausage cheese5 cheese4 cheese3 cheese2 cheese







The following foods have limited amounts of tyramine. It’s okay to consume up to 1/2 a cup daily.












I assembled the list from Wikipedia and a dozen medical sites. None of the sites list all of these items. The list on the Mayo Clinic site is typical:

“Tyramine is naturally found in small amounts in protein-containing foods. As these foods age, the tyramine level increases. Some foods high in tyramine include:

  • Aged cheeses, such as aged cheddar and Swiss; blue cheeses such as Stilton and Gorgonzola; and Camembert. Cheeses made from pasteurized milk are less likely to contain high levels of tyramine, including American cheese, cottage cheese, ricotta, farm cheese and cream cheese.
  • Cured meats, which are meats treated with salt and nitrate or nitrite, such as dry-type summer sausages, pepperoni and salami.
  • Fermented cabbage, such as sauerkraut and kimchee.
  • Soy sauce, fish sauce and shrimp sauce.
  • Yeast-extract spreads, such as Marmite.
  • Improperly stored foods or spoiled foods.
  • Broad bean pods, such as fava beans.”

The amount of tyramine depends on how the food was processed and how old it is. Tyramine increases as a food ages. Pickled, smoked, fermented, or marinated meats are generally high in tyramine. Fresh produce is okay if you eat it within 48 hours of purchase. Nuts are never okay. A draft beer contains 25 times as much tyramine as a can of beer.

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Hot Italian

Hot Italian Mangia & Bar

Emeryville Public Market
510 922 1369


hotitalianWe were in the neighborhood, having done a run to the Emeryville Ikea, and decided to drop by the Emeryville Public Market for the first time in more than a year. It’s a shadow of its former self. Several food stalls have disappeared. Remodeling has reduced the seating area. Once a vibrant space (remember the fish market? the gourmet cookware shop?), the Public Market has clearly seen better times.

Hot Italian is the exception. It’s a bustling upscale pizza joint with a thoroughly Italian menu and vibe. Our Basso pizza with artichoke hearts, heirloom cherry tomatoes, roasted olives, basil pesto, mozzarella, and tomato sauce ($16) was delicious. The Izzo salad (baby spinach, plums, goat cheese, and marcona almonds ($9) was tasty but could have used a little more dressing. My Bellini ($7) was perfect.

The restaurant feels like a warehouse, but a sparkling warehouse in Milano.

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This week

Gumbo at Angelina’s

Crab melt at Pacific Catch

Jack Satan margarita at Comal

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Fourth Street


This tasteful Japanese-inspired restaurant has taken the place of the former O Chamé, my one-time favorite restaurant in Berkeley.iya2

The new place retains the furniture and feel of O Chamé. I’m disappointed they covered up the fresco buddha in the main dining room; for feng shui  it was carved into the wet plaster with a fork.iya3

Service was excellent. My waiter was attentive. iya4My salmon was perfection. More food pics.

Iyasare isn’t cheap, but neither was O Chamé. The menus and pricing reflect what came before.

I’d love to see them resurrect O Chamé’s bowls of soba with great toppings.

I’ll be back.


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Decadent dessert

To finish lunch at Il Davide in San Rafael, I ate a lemon semifreddo to die for.

semimIt was served on a block of salt!


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Windy day at Internet Time Lab

We awoke this morning to find tree-sized limbs from our redwoods littering the new redwood deck in back. No major damage done.

Deck after storm

Deck after storm

Deck after storm

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The new travel experience

trip logo

Go to TripAdvisor

berkeleyPick a place you know

trip3Select someone with hundreds of reviews

trip4Click “Rating” to dredge the bad reviews to the top

Read this stuff — and the replies from the struggling hotel manager

Some reviewers are sick people

Other reviewers are the competition in disguise


Click “Rating” again

Can this be the same place?


I’m scouting out places to stay in Zurich and Berlin next month

You know it ain’t easy

You know how hard it can be





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La France

I spent the last week in October in St. Jeannet, about half an hour out of Nice, with my fellow adventurous eater Philip. The eating was memorable.

Aphrodite, David Faure’s restaurant in Nice, is serving an insect menu. Note the worms protruding from this foam creation:

Nice - eating bugs

And a few crickets and foie gras:
Nice - eating bugs

And cod with tiny worms:
Nice - eating bugs

All matched with the proper wines:
Nice - eating bugs

The overall experience was great fun. Service at Aprhodite was excellent. As for the food, it might better be described as a menu with bug garnishes.

Despite the lovely bugs, Aphrodite can’t compete with my next fantastic meal.


Bruno is the Emperor of the Truffle. Five of us enjoyed an all-truffle meal at Chez Bruno, a lovely place out in the countryside. We started with truffle toasts:

Chez Bruno

Next up, a chestnut velouté with foie gras and truffles:

Chez Bruno

Then a potato in truffle sauce, topped with white winter truffles:

Chez Bruno

Pigeon with truffles and celery remoulade:

Chez Bruno

And the pièce de resistance, truffle ice cream:

Chez Bruno

And a few shots of vieux calva:

Chez Bruno

A glorious meal.

Chez Bruno

Chez Bruno

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