All medications can have potential side effects. For patients taking a certain class of antidepressants known as Monoamine Oxidase Inhibitors (MAOIs), a dangerous spike in blood pressure can happen if they eat foods that are high in a substance called tyramine. Tyramine is an amino acid that is found naturally in many foods are that fermented, says Sunnybrook registered dietitian Karen Fung. Now, a new Sunnybrook recipe book is providing these patients with a safe roadmap through the kitchen.
The MAOI Diet Recipe Book is a collaborative project that Karen worked on with a team of experts at Sunnybrook, led by psychiatrist Dr. Ken Shulman. Importantly, it was also driven by a patient living with depression, Connie Reed. Here, Connie and Karen share their thoughts on this unique resource and the impact it will have on patients worldwide.
Connie
I’ve been living with depression for the past fifteen years. Taking MAOIs has helped improve my quality of life greatly, making it much more enjoyable. Before I was prescribed these drugs, my doctor explained the importance of following an MAOI diet. There just weren’t many resources available on the subject.
During the pandemic, my friend Carol and I worked together sorting through a variety of recipes and adjusting them to MAOI diet requirements. Carol is very close to me and enjoys making meals for me but they have to be adjusted. For example, when making macaroni and cheese, we used a type of cheese that doesn’t contain tyramine. Carol and her husband taste-tested each recipe we worked on.
Karen
Having Connie and Carol’s input was integral to putting this recipe book together. It’s backed by leading Sunnybrook research and it also comes from an actual patient’s experience. Connie and Carol developed a lot of these recipes and provided many cooking tips. It’s easy for anyone to use and understand.
Dr. Shulman’s research has shown the use of MAOIs has declined significantly over the past 10 years, partly due to other medications being available. But many clinicians also avoid prescribing MAOIs because of this interaction with diet, and they may not be confident in what resources are available for patients to tap into. This is a concern as MAOIs represent the best option for some patients with treatment-resistant depression. As Dr. Shulman has noted, this recipe book is a huge step forward in providing research-based recommendations.
The book is easy to navigate and provides some important background and context. Tyramine is an amino acid that is found in various foods, but in much higher concentrations in foods that are aged or fermented. Some common foods that are high in tyramine include aged cheese, air dried sausages, kimchi, miso, sauerkraut and beer on tap.
On the flip side, the safe foods to eat while taking these MAOIs are all low in tyramine, which include fresh products. So fresh meat, fresh produce and fresh dairy products, like ricotta and feta cheese. Red wine is also safe for patients taking MAOIs.
Connie
As a patient, this recipe book has made me even more aware of the importance of the MAOI diet. It’s so helpful because it provides accessible information for patients as well as friends and families of people on the diet. If they want to cook a meal, they have a huge selection of safe recipes to choose from. In fact, it’s dedicated to the families and friends of those of us on MAOI medications, and their loving efforts to prepare delicious meals that are safe for us to enjoy.
Karen
Because there are so many myths and misconceptions out there, it’s important to rely on the experts to get recommendations, especially when people want to use this on an individual basis. From vegetarian options to hearty mains and salads to desserts, there really is something for everyone to enjoy.
