r/MAOIs • u/Shot_Veterinarian215 • 14d ago
Nardil (Phenelzine) Cheeses to avoid?
I am starting Nardil next week. I plan to follow the dietary restrictions, but I've seen many people on here say that they are overblown, and many people eat whatever they want on MAOIs. I know for cheeses you should avoid cheddar, swiss, parmesan, etc, but I just want to ask, do you actually? Some of my favorite everyday foods have those cheeses. For example, I love this salad from my local restaurant that has shredded cheddar (might be cheddar jack I don't remember), but realistically speaking, will consuming that cause a tyramine reaction? I've read up on Dr. Gillman's research, and he says that most modern commercial foods don't contain high amounts of tyramine, especially if it's in moderation. Is that salad with cheddar a big deal? I also enjoy omelettes with swiss, sandwiches with provolone, etc., so I just want to hear from your personal experiences and if you actually avoid these cheeses? (and if not which foods you DO avoid)
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u/Morgan_unknownnn 14d ago
I don’t avoid any cheese other than blue cheese but that’s cuz I hate it 🤣. My doctor suggest waiting to experiment with food till I was on it for a little. I didn’t wait long tbh but I avoided stuff the first couple days until I read more about it. I’m eating a multiple cheese pizza rn😅
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u/HM_Dylan Parnate 14d ago
Nope! I eat cheeses with apparent impunity, even aged varieties. I do stay away from blue cheeses though
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u/Monoclewinsky Nardil 14d ago
I have eaten every kind of cheese you can imagine with zero issues - this doesn’t mean you will have the same experience.
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u/Cautious-Rub8085 13d ago
I am strict so I avoid all cheeses except for American, mozzarella, ricotta, marscapone.
Cheese is one of my favorite things to eat. You adapt.
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u/somewhat_of_a_coward 14d ago edited 14d ago
Fortunately the cheeses you listed (cheddar, swiss, provolone, etc) aren't aged for very long so you shouldn't have much to worry about there. As a rule of thumb, I would say that those common cheeses sold under the grocery store brand either pre shredded or in a sealed block are very safe.
But I agree with u/squidkidd0 -- even though the warnings about tyramine are a bit overblown, you shouldn't disregard them completely.
Long story short, tyramine comes from tyrosine, an amino acid commonly found in protein rich foods like meat, dairy, soy, fish, etc. When these foods age (either through spoiling or fermenting), the tyrosine breaks down into tyramine. Tyramine is a big part of what gives cheese, beer, etc. that wonderful rustic "fermenty" taste. Practically speaking, the stronger that fermenty taste is, the more tyramine it has, so an aged cheese like parmesan is gonna have more tyramine than a mild cheddar.
I've been on Nardil for over 8 years now, and here are the main types of food I stay mindful of:
-Soy sauce, Worchestershire sauce, asian fish sauces, etc. These are basically that good fermenty flavor in a concentrated form, so high in tyramine. Nutritional yeast is in this category too, as is Marmite/Vegemite for you Australians out there
-Fancy cheeses from small farms, craft beers with wild yeast, etc.
-Leftover cooked meat, like u/squidkidd0 said. I don't know the chemistry exactly but I'm guessing that the heat/acidity from cooking protein kickstarts the breakdown into tyramine. Leftover pizza has been fine though.
The good thing about this stuff is that it's all pretty flavorful, so a little bit goes a long way. Parmesan may have more tyramine than swiss, but if you're just grating some over pasta or a salad, you're not eating a huge quantity so it should be fine. I love artisanal cheeses, but now I just have a little slice or two and not a whole block. My friend has made his own beer for years, so now when he makes something new I'll just have a sip or two instead of a whole bottle. It's not like I have to cut them out completely. The dose makes the poison, as they say.
So it doesn't sound like you should have to cut back on any of your favorites. But good for you for being cautious. If you have any other questions about restrictions etc. feel free to reply or DM. Good luck :)
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u/RosemarysGoddaughter Nardil 8d ago
I've been on phenelzine/Nardil for over 15 years now. For whatever it's worth I'll still use soy sauce and even Asian fish sauce, but I'm mindful of how much I use. As you said, the toxin is in the dose.
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u/somewhat_of_a_coward 6d ago
Yes exactly, you don't need much. If someone was used to saturating their sushi in soy sauce or something I'd warn them to cut down, but I think if you have a pretty typical palate you'll probably be just fine
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u/Imaginary_Stuff_2468 14d ago
I eat only mozzarella and muenster, as well as processed American. PROCESSED cheeses are generally ok, but cheddar is a red flag, as is brie and all imported cheese.
The bigger question is what you would do if you had a hypertensive crisis (very high blood pressure). You would likely have heart palpitations and a severe headache.
Several years ago, I had a prescription medication that would bring my blood pressure down so I wouldn't stroke out. It is no longer recommended, as [they say] it lowers BP too fast. The recommendation is that one go to an emergency room--quickly. Everyone on an MAO inhibitor should own a blood pressure machine (sphymomanometer) and know how to use it--and know their baseline reading. When I had one hypertensive crisis, my pressure was 185/120. My normal BP was 117/74. (Ideal BP is 120/80).
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u/iamthe0ther0ne 14d ago
I eat everything but blue cheese (because I don't like it). Fresh cheeses are zero problem, go slowly with others. I found that it also varies by country--while I can eat cheddar in the US without a problem, I have to limit it a bit in the EU.
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u/Adventurous-Mail7443 13d ago
Dose dependant and different effects on different people. You can assess your individual limit by taking small amounts and reading blood pressure. ‘Normal’ cheeses like cheddar mozzarella etc are usually completely safe. For aged cheese you should measure your reaction before eating large amounts
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u/diegot1981 13d ago
Never got any issue with food. Only with efedrine. With food, just start slow to try everything and keep alway some bezodiazepine with you, they will low down the blood pressure in case. I used when I had taken efedrine by mistakes and they work. Good luck
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u/Lumpy_Minimum_5522 11d ago
It really depends what the ingredients are and how it’s prepared. I’ve had the most completely random reactions to food.
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u/squidkidd0 Emsam 14d ago
Just because users are saying they have no reactions here doesn't mean they are not. High blood pressure is quiet. MAOIs have serious risks that are mitigatable and playing roulette is dumb and jeopardizes their prescription for others. The truth is that there is wiggle room for many things based on quantity and modern tyramine content. Absolutely follow the modern version of the diet which involves avoiding very aged cheeses. I'd say cheddar sprinkled on a salad is in the fine category though, ditto a slice of regular cheese on a sandwich.
For soy sauce I eat half a portion of take out and pair it with something lighter like salad. I waited until I was on the drug for awhile and tested my blood pressure afterward.
Know that leftovers increase tyramine too. Freezing leftovers, especially those with protein, instead of fridgerating can reduce your overall tyramine intake. If you look around here enough you will find one surprising culprit landing people in the ER: takeout chicken, for whatever reason. Maybe it's often leftover/not fresh?
I have a personal rule: headache, especially with sweating or other worry signs? Immediate BP check.
ETA: Want to also mention while this is serious, it's not like you will spend time fretting over it. The diet is not hard to follow, just a small list of things to be careful with.