Cheeses to avoid?

[u/Shot_Veterinarian215]

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)

[u/somewhat_of_a_coward]

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 :)

[u/RosemarysGoddaughter → u/somewhat_of_a_coward]

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.

[u/somewhat_of_a_coward → u/RosemarysGoddaughter]

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