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Dr. Bob is Robert Hsiung, MD,
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Posted by djmmm on March 26, 2002, at 9:52:50
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on March 23, 2002, at 13:33:03
From
http://www.vh.org/Providers/Conferences/CPS/19.htmlA retrospective analysis of the incidence of acute hypertensive crisis in 692 patients treated with MAOIs found that the incidence was 8.4% prior to instituting dietary restrictions but 3.3% after dietary restrictions were imposed (Bethune 1964). In the Rabkin chart review (1985) study, 11 patients (8%) on phenelzine and one patient (2%) taking tranylcypromine experienced hypertensive reactions.
The Rabkin, et al study included 198 patients
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6386898&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3973068&dopt=Abstract
Posted by Elizabeth on March 26, 2002, at 18:44:40
In reply to Re: MAOI diet short list, posted by djmmm on March 25, 2002, at 17:31:49
> I couldn't agree more. When the "list" was originally created, all food that contained tyramine was restricted, regardless of content, etc.
It's even worse than that. There were also foods that don't contain significant amounts of tyramine (or other biogenic amines); they were included based on old and flawed techniques for measuring the tyramine content (such as Chianti), vague and poorly documented case reports (e.g., chocolate), etc., as well as foods that were simply related to foods that were known (or believed) to interact with MAOIs (for example, based on putative interactions with a few types of alcoholic drinks, the recommendation was made that people avoid *all* alcoholic drinks).
The effect of all this has been (not surprisingly) much like the effect of telling kids that marijuana is a highly dangerous and addictive drug: once people realize that they can "cheat" on the diet, they don't take *any* of the recommendations seriously -- even the ones that really should be taken seriously.
> The MAOI diet is based on poor scientific evidence, and shouldn't be a factor when deciding depression treatment.
Well, the old MAOI diets are (there are many, many different versions). That's why some Canadian researchers went and did the actual research to figure out which foods actually should be avoided. (This research is the main basis for my version of the dietary restrictions list.) There are still doctors out there who use one of those invalid lists that contain a lot of foods that shouldn't be included, though. Educate them, everybody! :-)
-elizabeth
Posted by LLL on July 13, 2002, at 12:40:18
In reply to Re: MAOI diet short list, posted by mdmicky on March 2, 2002, at 14:55:10
I am on Parnate again after a 4 year break and am not remembering some of the diet restricitons. Is canned tuna OK? what about the use of Lipton soup mixes (the dried variety) for cooking? Is everything with yeast extract and soy protein out? I haven't heard anything mentioned of MSG, isn't that a big no-no?
Posted by Bobbiedobbs on July 14, 2002, at 23:18:38
In reply to Re: MAOI diet short list, posted by LLL on July 13, 2002, at 12:40:18
To answer your question, canned tuna is fine, same with lipton's soup mix. I never had any particular problem with MSG and don't know of any. Yeast extract I guess is a no-no. Regarding soy protein, I recently had an extensive dialogue with the folks at the company that makes Parnate (Glaxo) concerning a variety of soy=based products. Rather than commit to memory I will find my notes later this week and post. The general rule was soy was OK but fermented soy was not, and that included a lot. You have to keep in mind that these are the folks who say you can't have chocolate or yogurt! Will post what company doctors said vis-a-vis soy. If you look at some of the earlier messages, I think Elizabeth had a good post on soy products.
Posted by LLL on July 15, 2002, at 10:08:03
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 14, 2002, at 23:18:38
> To answer your question, canned tuna is fine, same with lipton's soup mix. I never had any particular problem with MSG and don't know of any. Yeast extract I guess is a no-no. Regarding soy protein, I recently had an extensive dialogue with the folks at the company that makes Parnate (Glaxo) concerning a variety of soy=based products. Rather than commit to memory I will find my notes later this week and post. The general rule was soy was OK but fermented soy was not, and that included a lot. You have to keep in mind that these are the folks who say you can't have chocolate or yogurt! Will post what company doctors said vis-a-vis soy. If you look at some of the earlier messages, I think Elizabeth had a good post on soy products.
More questions - what about the use of vinegar? distilled white vinegar, rice vinegar, tarragon white whine vinegar as well as Marsala cooking wine and sesame oil. Can these be safely used during cooking while on Parnate?
Posted by LLL on July 15, 2002, at 14:57:33
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 14, 2002, at 23:18:38
Thank you for your response. After taking a closer look at the dry packaged Lipton Soup Mix box as well as the cans of Swansons beef and chicken broth, they all contain yeast extract and or autolyzed yeast extract and thus sound like they should be prohibited. I used to use both a lot in my cooking. I also noticed a can of re-fried beans that I have contains autolyzed yeast extract. I always remember before while on Parnate ('93-'97), looking out for MSG but never yeast extract. I'd appreciate you getting back to me on the soy protein and soy flour as I don't eat meat (just turkey/chicken/fish) and some of the convenience foods and snacks I use contain these.
I also have a question about "leftovers". If I make a meal with turkey/chicken one night, I cannot have it again the next? Also, what about marinating meat for several hours in the fridge (I make my own marinade) before cooking?
As you can see I'm very anxious about starting this medication again and having a hypertensive crisis. Thanks.
Posted by Bobbiedobbs on July 16, 2002, at 0:23:58
In reply to Re: MAOI diet short list, posted by LLL on July 15, 2002, at 14:57:33
I happened to be exploring vegetarianism and posed the question of food tolerances to specialist at GlaxoSmithKline, the company which manufacturers Parnate. He told me to refrain from the following: Tofu, Tempeh, Tamari Sauce, soy sauce and any kind of fermented soy bean product or fermented bean curd (PLUS mISO SOUP!!) I'd just note here that others who have posted on this site have said that tofu (if not fermented) was OK. While your doctor or pharmacist should be able to answer questions, I've found the folks at GlaxoSmithKline to be very helpful. The Customer Service Line 1-888-825-5249.
I've taken Nardil (another MAO) and Parnate for years and never had a problem with any type of cooking vinegar or sesame oil. Marsala wine, strictly speaking, is on the no-no list but I've had Marsala wine and sauce without any problem.
For the first several years when I was taking an MAO I watched my diet like a hawk. I loosened the food restrictions considerably after reading several studies published in the Journal of Clinical Psychiatry (March, 1996) and Lancet. These studies actually measured tyramine content and did exhaustive reviews of literature. The conclusion was that MAOI diets were excessively restrictive and founded on poor scientific evidence. They recommend users avoid aged cheeses, aged or cured meats, potentially spoiled meats, broad bean pods, yeast extract, sauerkraft, soy sauce and 'soy bean condiments" but considered wine (red or white) and domestic or bottled beer safe in moderation (as well as mozzarella and processed american cheese!). Anyway, on the foods of interest to you, they (David Gardner, Kenneth Shulman, Scott Walker and Sandra Tailor, Dpt. of psychiatry, Sunnybrook health Science Centre, Toronto, Canada state the following:
"Other yeast extracts (e.g. brewer's yeast) contain no significant amounts of tyraminE nor do (MSG) or gravies made from fresh stock and or beef or chicken bouillon. As to yeast extract, the Univ. of Toronto diet lists "marmite concentrated yeast extract" as "food to avoid" but "other yeast extracts, e.g. brewer's yeast," as "food allowed". Soy milk is also specifically on the allowed list.
Eating leftovers is no problem as long as the food itself is safe, is adequately refrigerated and there has been no spoilage or post-preparation aging.
In all the years I and a handful of other people I know have taken these medications, the only severe reactions have occurred from aged cheese on a pizza and from a decongestant.
Hope this helps more than confuses. It's too bad that these meds are so restrictive but if you can get the hang of them, they can be extremel helpful - actually worth it. Nardil, at least, helped me tremendously. Good luck! Phil
Posted by cybercafe on July 16, 2002, at 2:29:33
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 0:23:58
>GlaxoSmithKline to be very helpful. The Customer Service Line 1-888-825-5249.
Awesome... someone said elizabeth called and found they measured the tyramine in different types of soy sauce, is that right?
>(David Gardner, Kenneth Shulman, Scott Walker and Sandra Tailor, Dpt. of psychiatry, Sunnybrook health Science Centre, Toronto, Canada state the following:
ah yes sunnybrook... i'm sure the pdocs are above average there... also a hospital with an emergency ward known to interview and turn away psychotic and suicidal patients... currently at least one law suit against them i know of ...
... too bad you have to suffer permanent and severe injuries to be able to charge someone who is obviously wrong...
<rant off>
Posted by KellyM on July 16, 2002, at 8:55:32
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 0:23:58
Thank you for putting down your thoughts here... I found them helpful. Nardil is helping me :-)
Posted by LLL on July 16, 2002, at 10:21:15
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 0:23:58
Thank you sooooooooo much! I've been on Parnate before (found it to have less side effects than Nardil) and it was a miracle drug for my panic disorder and agoraphobia. I'm hoping it will help again. Thank you so much for all your helpful advice!
Lisa
Posted by jsarirose on July 16, 2002, at 14:27:04
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by LLL on July 16, 2002, at 10:21:15
RE: MAO Diet
Keep in mind that the lists were re-done in 1996. Take any information from lists pre-1996 with a grain of salt. There are a lot of things that were previously prohibited that are now found to be fine.
General rule of thumb is aged products - that doesn't mean self-aged as in leftovers & marinades. You have to be a little careful with fruits and vegetables and leftovers that they aren't too far gone, but that's basically true anyway.
I had a hard time finding soups and broths without autolyzed yeast as well. Check out some Asian mixes and the more expensive pure boullions.
Vinegar is fine, as is soy sauce in moderation (1 tbsp or so at most). Tofu is fine, but not tempeh as it is fermented.
And don't forget that many cold meds are also not allowed!
Fresh cheeses are allowable, as in: mozzarella, montrachet, chevre, ricotta, cottage, cream cheese, etc. (Mozzarella has been a life saver for me as I'm a cheese-aholic!)
And the item about beer is general, tap beers or micro-brews can be dangerous, but big brand, pasteurized beer is fine.Here are some sites I found helpful:
http://www.holisticonline.com/Remedies/Depression/dep_interactions_MAOI.htm
http://www.urmc.rochester.edu/miner/docs/pated/drugshts/mdiet.html
http://health.wchsys.org/carenotes/nd2007g.htmGood luck!
-Jessica
Posted by cybercafe on July 16, 2002, at 14:55:23
In reply to Re: MAOI diet short list, posted by jsarirose on July 16, 2002, at 14:27:04
anyone with a non-pre-existing blood pressure condition have any hypertensive experiences they'd like to share.... especially those on lower doses (i'm on 30 mg of parnate, and eat pepperoni pizza with no probs) ...
Posted by LLL on July 16, 2002, at 16:22:57
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by KellyM on July 16, 2002, at 8:55:32
re: calling Glaxo Smith Kline for info on food restrictions with Parnate. Called today and they could not give me any info other than what is on the package insert. They told me only a health care provider would be able to discuss things further. My pharmacist was gracious enough to call for me with my list of questions and was told they would fax her the responses. After waiting all day, she received a fax stating she could look up two articles to read!
What clout do you all have, or what is the magic word enabling you to reach these experts?!
Posted by Bobbiedobbs on July 16, 2002, at 23:00:35
In reply to hypertensive experiences? , posted by cybercafe on July 16, 2002, at 14:55:23
I've taken nardil for 15 years and parnate for 2 years. Nardil dose was 30-60 mg. parnate dose has been 20-40 mg. I've eaten zads of pepperoni, pizza with sausage, pepperoni, etc. (but being careful to confine the cheese on it to mozarrela and ricotta), and had way too much wine and beer on a number of occasions. The only thing I've really avoided has been aged cheese, Miso soup and the various decongestants and other conflicting medications.
Only two reactions in that time:
(a) 15 years ago took a decongestant by mistake. It was pretty ugly. I started sweating and getting a piercing headache immediately and blood pressure was way high. On doc's advice, I took Melaril to bring blood pressure down. then I took a second Melaril and it did the trick. Second reaction was from a Turkish pizza that the server swore up and down (in Turkish, perhaps) had no cheese. Reaction was sweating and a blinding headache that lasted for several hours; however, blood pressure did not rise all that much. I know several people taking Parnate and/or Nardil and the only reaction was to a dufus who ate a "three-cheese pizza". The drug company says you have several hours to get to a hospital. The manufacturer recommends a particular antidote whose name escapes me, if it is important I can tell you. My current doctor gave me a different antidote which I carry around just in case. Phil.
Posted by Bobbiedobbs on July 16, 2002, at 23:29:54
In reply to Re: MAOI diet short list » KellyM, posted by LLL on July 16, 2002, at 16:22:57
Sorry you didn't get as much help as I did. All I can think of is that (a) I was asking stuff that went beyond the list they already provided, so they were apparently willing to cooperate (b) I was previously a consumer reporter and can be pretty persistent/solicitous - a good combination generally (c) I was fortunate on the two occasions I called. (d) they were swamped with calls from people who saw the phone #. If you really get stuck on something you can let me know what the question is and I'll give it a try. Actually, I've had pretty good luck with my own pharmacist on a few occasions. Phil.
Posted by ayrity on July 16, 2002, at 23:54:53
In reply to hypertensive experiences? , posted by cybercafe on July 16, 2002, at 14:55:23
Hi cyber-
I wrote before about a hypertensive reaction I had on 30 mg Parnate- I've been on it about 4 weeks now. The first time I had a reaction I thought it was food related, since it was about 1 hour after lunch, but I did not eat anything unusual or provocative.Since then, I've had multiple high spikes in my BP within 1/2 hour after taking a dose of Parnate, unrelated to food, whether I've eaten or not. Spontaneous hypertensive reactions, though rare, are known to occur with Parnate. It figures I'd be one of the rare ones! Like I wrote before, every med I've tried I've gotten all of the side effects and none of the benefit. Very frustrating. I was hoping this would work this time- I've been through Celexa, Celexa + Wellbutrin, Wellbutrin alone, Effexor, Provigil- never felt better on any of them, only side effects. Since it seems I have atypical depression (for which MAOIs are often the best choice), my doc and I had high hopes for Parnate.
We spread out the dose of Parnate over the day, which seems to help a bit but my BP still spikes occasionally. I might have to stop it and switch to Nardil or Marplan if there's no improvement.
Posted by jsarirose on July 17, 2002, at 1:02:18
In reply to Re: hypertensive experiences? , posted by Bobbiedobbs on July 16, 2002, at 23:00:35
I have had two "accidents" as well with similar results. Once I ate a seafood stew which had smoked clams in it (everything else was fresh so I assumed the clams were too). And another time I had Vietnamese Pho which has anchovy paste in it. (Took a while to figure that one out!)
Both times I got a pounding, sudden migraine about an hour after eating. It hurt horribly. The first time I called and my doctor was out. The doctor on call wanted me to take my blood pressure which, of course, I couldn't at home. He wouldn't let me take my "emergency" pill and suggested I take some Advil and lie down. Well, the last thing you can do when you have a migraine is lie down. I took to pain pills I had left over from surgery and eventually it faded.
The second time I called my doctor. She said to take the "emergency" pill. If my blood pressure was high it would bring it down and if not it wouldn't hurt me. I took it and one pain pill. I started to feel better very soon. Both times I had residual headaches (not migraines) for a couple days after and slept a lot.
RE: the emergency pill. My doctor prescribed Chlorpromazine (thorazine). It doesn't give you the famous drooling side effects if you only take it very occasionally. It's also safe to take even if you aren't technically in hypertensive crisis.
I also bought a home electronic blood pressure kit. I didn't think I'd be able to take my blood pressure manually in a crisis, but the automatic one is easy. I take it periodically to maintain a diary of my regular blood pressure too.
-Jessica
Posted by cybercafe on July 17, 2002, at 1:22:01
In reply to Re: hypertensive experiences? , posted by ayrity on July 16, 2002, at 23:54:53
> Hi cyber-
> I wrote before about a hypertensive reaction I had on 30 mg Parnate- I've been on it about 4 weeks now. The first time I had a reaction IHey thanks a lot for replying -- much appreciated.
Might I ask if you have any health condition that might be implicated in this spontaneous reaction?
... oh btw how bad were the spikes? and did they involve physical symptoms like majorly painful headache?
Posted by cybercafe on July 17, 2002, at 1:28:14
In reply to Re: hypertensive experiences? , posted by jsarirose on July 17, 2002, at 1:02:18
hey Jess.. you don't remember me from ASDM? :)would you happen to know if all Pho is bad... or just that particular one?
Posted by jsarirose on July 17, 2002, at 1:36:15
In reply to Re: hypertensive experiences? , posted by cybercafe on July 17, 2002, at 1:28:14
>
> hey Jess.. you don't remember me from ASDM? :)
>
> would you happen to know if all Pho is bad... or just that particular one?Of course I do! I always remember my fellow Parnate ingestors. When I looked up Pho recipes on the web I found some contained anchovy paste and some did not. I called the restaurant I ate at and they did use paste in their broth. Since many Pho restaurants are run by heavily accented workers, I decided it would be risky to try it again.
I would be careful about Pho unless you can ask the employee about the ingredients and be sure he gives you a clear and honest answer. It has also made me much more wary about other asian dishes. I still eat ethnic, but if I don't know the ingredients I always ask. And if I'm not sure about the language barrier I don't chance it. After two attacks - I definitely don't want another! Of course, even if I knew it had anchovy paste in it I wouldn't necessarily known it wasn't allowed. I had to look that up too!
-Jessica
Posted by LLL on July 17, 2002, at 9:30:57
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 23:29:54
Well if you wouldn't mind - I'm still unsure (anxious) about some things. NO Broad beans - are Sugar Snap Peas in their pods included? Again, soy protein and soy flour - OK? Someone posted a reaction to buttermilk pancakes with soy flour! If I make my own chicken broth and thus eliminate the yeast extract found in canned broth, and then freeze it, do I have to worry about the age of the broth before using? And in regard to Marsala wine - I don't drink wine, but I cook with it, if the Marsala wine is used in making a sauce and cooked is that OK? Lastly, are there any frozen convenience foods out there that can be consumed that don't contain autolyzed yeast extract or yeast extract (both no-no's)?
Thanks
Lisa
Posted by jsarirose on July 17, 2002, at 14:11:03
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by LLL on July 17, 2002, at 9:30:57
> Well if you wouldn't mind - I'm still unsure (anxious) about some things. NO Broad beans - are Sugar Snap Peas in their pods included? Again, soy protein and soy flour - OK? Someone posted a reaction to buttermilk pancakes with soy flour! If I make my own chicken broth and thus eliminate the yeast extract found in canned broth, and then freeze it, do I have to worry about the age of the broth before using? And in regard to Marsala wine - I don't drink wine, but I cook with it, if the Marsala wine is used in making a sauce and cooked is that OK? Lastly, are there any frozen convenience foods out there that can be consumed that don't contain autolyzed yeast extract or yeast extract (both no-no's)?
> Thanks
> Lisa
Broad beans are specific type of bean, same as fava beans. They aren't very common, but you need to be aware. Other beans and peas are just fine.Soy protein & soy flour should be fine, it was probably the buttermilk that created the reaction. (This is my opinion gleaned from the information I have read - not fact.)
Making your own chicken broth and freezing it is just fine. Some of the organic broths are also made without out yeast.
Marsala wine in cooking is fine. In fact, unless it's homemade - wines in moderation are just fine. I can't imagine needing so much to cook with (and consuming enough of the dish) that you would ingest more than the equivalent of two glasses of wine!
I've had a hard time finding frozen/convenience foods too. I seem to have better luck in the natural or organic section of the store although they are pricier. Things without sauces tend to be yeast free as well. (Yeast isn't the enemy, just autolyzed yeast and yeast extract - I say yeast in these foods because it's easier to type.)
-Jessica
ps - you'll get the hang of it soon and be able to figure things out on your own, it just takes a while to get the basic reasoning down.
Posted by SLS on July 17, 2002, at 14:31:46
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 16, 2002, at 0:23:58
Hi Phil.
You invested yourself wonderfully in taking the time to answer questions regarding MAOIs. It looks like you have ton of valuable research into the matter. I was wondering if you might want to put together for us your own short list of the of foods and medications that you know to be particularly dangerous. If not, perhaps you could list a few Web URLs that you think are worth looking at.
I have been on and off MAOIs for twenty years, and have not yet come across anything as definitive as the information it looks like you have compiled.
Thanks.
- Scott
Posted by SLS on July 17, 2002, at 15:03:20
In reply to Re: hypertensive experiences? , posted by jsarirose on July 17, 2002, at 1:36:15
Hi.
What are the best drugs to use to treat an MAOI reaction?
I have carried nifedipine (Procardia) around. Is that the best? I had never heard of the usage of Mellaril until someone here mentioned it.
The old recommendation for treating an MAOI hypertensive crisis in the hospital was to use Regitine, an injectable form of phentolamine. Phentolamine is a nonselective NE alpha receptor antagonist that I believe works to relax blood vessels. I'm pretty sure that an oral form was once available, but not since at least 1982. I was hoping that an oral form of phentolamine would once again appear, as it was being looked at for treating erectile dysfunction. However, I don't think the initial clinical studies showed enough efficacy to pursue it as such.
- Scott
Posted by jsarirose on July 17, 2002, at 15:24:49
In reply to Re: hypertensive experiences? , posted by SLS on July 17, 2002, at 15:03:20
I can't say what is the best, but I can say what my doctor gave me: Chlorpromazine (50mg), aka: Thorazine. It works well for me and I like the idea that it won't harm me if I'm having an attack but my blood pressure isn't necessarily heightened (couldn't always tell before I had my own BP monitor). It does make me tired for while - but it works pretty quickly.
-Jessica
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