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.
In 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.
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.
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.)
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:
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.
Emeryville Public Market
510 922 1369
We 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.
Service was excellent. My waiter was attentive. My 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.
To finish lunch at Il Davide in San Rafael, I ate a lemon semifreddo to die for.
We awoke this morning to find tree-sized limbs from our redwoods littering the new redwood deck in back. No major damage done.
Go to TripAdvisor
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
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:
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:
Next up, a chestnut velouté with foie gras and truffles:
Then a potato in truffle sauce, topped with white winter truffles:
Pigeon with truffles and celery remoulade:
And the pièce de resistance, truffle ice cream:
And a few shots of vieux calva:
A glorious meal.