title: Refining the MAOI diet: tyramine content of pizzas and soy products.
abstract: BACKGROUND
  Continuous refinement of the monoamine oxidase inhibitor (MAOI) diet has resulted in much reduced and simplified recommendations that attempt to balance safety and practicality. In the spirit of evidence-based practice, dietary restrictions should be based on carefully documented case reports and valid tyramine analyses. Residual concerns have focused on combination foods such as pizza and a variety of soy products. We determined the tyramine content of pizzas and a variety of soy products in order to refine dietary recommendations for use with MAOIs.
  
  
  METHODS
  High-pressure liquid chromatography analysis of tyramine content was performed on a variety of pizzas, soy sauces, and other soybean products. A tyramine level of 6 mg or less was considered safe.
  
  
  RESULTS
  No significant tyramine levels were found in any of the pizzas, including those with double pepperoni and double cheese. Marked variability was found in soy products, including clinically significant tyramine levels in tofu when stored for a week and high tyramine content in one of the soy sauces.
  
  
  CONCLUSIONS
  Pizzas from large chain commercial outlets are safe for consumption with MAOIs. However, caution must be exercised if ordering pizzas from smaller outlets or gourmet pizzas known to contain aged cheeses. All soybean products should be avoided, especially soy sauce and tofu. Individualized counseling and continuous surveillance of compliance are still essential.
authors: Department of Psychiatry, University of Toronto, Sunnybrook Health Science Centre, Ontario, Canada.
authors: K I
authors: KI
authors: Shulman
authors: S E
authors: SE
authors: Walker
mesh_terms: D000208:Acute Disease; D001939:Bread / Q000032:analysis; D002611:Cheese / Q000032:analysis; D002851:Chromatography, High Pressure Liquid; D004032:Diet / Q000009:adverse effects*; D005504:Food Analysis / Q000706:statistics & numerical data; D018565:Food-Drug Interactions; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects*; D013025:Glycine max / Q000737:chemistry*; D014439:Tyramine / Q000009:adverse effects* / Q000032:analysis
chemical_list: D008996:Monoamine Oxidase Inhibitors; D014439:Tyramine