Tyramine-restricted diet

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 strictly 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.

Cheese syndrome

It is not only patients taking MAO inhibitors who experience problems after ingesting tyramine. Some people get stabbing headaches or a migraine attack after eating products high in tyramine. They suffer from the so-called 'cheese syndrome'. Annoying, but not dangerous like the cheese reaction in MAO inhibitor users. 

Follow a tyramine-restricted diet for trip therapy

If we recommend following a tyramine-restricted diet with trip therapy in mind, it is due to the following principle. Tyramine, serotonin, dopamine, and psilocin are examples of monoamines that are all broken down by monoamine oxidase. If you have a high amount of tyramine in your diet in the days leading up to the trip therapy, your body will react by making more MAO available. The higher MAO content corrects the excessive tyramine levels so that you do not experience physical symptoms. Meanwhile, the increased MAO activity also immediately lowers your serotonin and dopamine levels, resulting in a down effect. As soon as you undergo trip therapy with psilocybin, the body will convert psilocybin into the monoamine psilocin, and this too is partially and more rapidly broken down due to the high MAO content. Therefore, with a tyramine-restricted diet, we ensure that the trip therapy works better because psilocin is broken down less quickly.

What is tyramine found in?

We advise you to avoid a number of products during the 2 to 3 days before the trip therapy.

Here is our advice regarding nutrition:

• Fruit varieties: No restriction
• Vegetables: No sauerkraut
• Herbs: No licorice, St. John's wort, or ginseng.
• Meat: No raw, smoked, or cheese-prepared meat or fish.
• Sliced meats: No sliced or processed meats
• Dairy: No cheese, no unpasteurized milk
• Seafood: No shrimp paste
• Notes: No restriction
• Bread: No sourdough bread
• Soy products: No tempeh, soy sauce (ketjap), fish sauce, Tamri, and Worcestershire sauce
• Drinks: No herbal tea with St. John's wort and/or licorice.
• Alcoholic beverages. Non-alcoholic beverages.
• Yeast: No Marmite, Tartex, brewer's yeast, bread drink, or Maggi.
• Ready-made meals: All non-fresh meals are not recommended. Even your own leftovers must be cooled down quickly and consumed within 24 hours.

Eat as little processed food as possible and always go for the freshest products. Preparing your own meals from fresh ingredients is much healthier in several respects and will contribute to an overall improvement in your (mental) health.

Other matters for the trip session

Absolutely no drugs must be used in the two weeks prior to trip therapy. The use of MAO inhibitors and other psychoactive medication must be tapered off first. Additionally, it is best not to smoke during the run-up to the trip session.

Via the link more information about medication in combination with psychedelic therapy and why tapering off is beneficial.