Cheese syndrome

Cheese syndrome

Cheese syndrome essentially involves experiencing symptoms caused by excessive tyramine. Tyramine can accumulate due to the use of MAO inhibitors (MAOIs). Some antidepressants fall under the category of MAO inhibitors, as does ayahuasca. Cheese syndrome occurs in people who do not take MAO inhibitors.

What is tyramine?

Tyramine is a monoamine found, for example, in aged cheese and other products. Tyramine can be formed under the influence of bacteria. Bacteria produce it from the amino acid tyrosine, which is a building block of various proteins. In protein-containing products that are stored or ripened, the tyramine content increases due to the breakdown of tyrosine into tyramine. As a result, aged cheese contains much more tyramine than young cheese. Other food processing methods, including fermentation, yeast fermentation, and smoking, lead to an increase in tyramine content.

Tyramine plays a role in regulating blood pressure. An excess of tyramine in your blood can cause high blood pressure, resulting in symptoms such as headaches. Normally, you do not experience any problems from this because certain enzymes break down tyramine. These enzymes are collectively known as monoamine oxidase, abbreviated as MAO.

MAO inhibitors

Certain medications inhibit the action of monoamine oxidase. These classic, or non-selective, MAO inhibitors are prescribed for depression and anxiety disorders when other antidepressants do not work. If you use this medication, your body does not break down tyramine from food sufficiently.

If you consume products containing tyramine in combination with these medications, the concentration of tyramine in your blood becomes too high. As a result, your blood pressure can rise dramatically in a short time, which can be accompanied by stabbing headaches and, in the most severe cases, a brain hemorrhage. This is known as the 'cheese reaction'. Therefore, with non-selective MAO inhibitors, you must follow a strict tyramine-restricted diet. Your treating physician and a dietitian can assist you with this. Nowadays, there are also selective MAO inhibitors where you do not need to be as careful with tyramine; you only need to watch out for large quantities of aged cheese.