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Dr. Bob is Robert Hsiung, MD,
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Posted by LLL on July 22, 2002, at 11:48:53
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 11:15:36
I wrote to "Lean Cuisine" and "Healthy Choice" and am hoping to get something back that will be helpful.
Received word from my general practioner in regard to prescribing an antidote for the Parnate - to quote his nurse "he won't touch it." Don't blame him - it's the psychiatrist's responsiblity! I'm sooooo frustrated!
Posted by jsarirose on July 22, 2002, at 11:55:11
In reply to Re: MAOI diet short list, posted by LLL on July 22, 2002, at 11:48:53
> I wrote to "Lean Cuisine" and "Healthy Choice" and am hoping to get something back that will be helpful.
> Received word from my general practioner in regard to prescribing an antidote for the Parnate - to quote his nurse "he won't touch it." Don't blame him - it's the psychiatrist's responsiblity! I'm sooooo frustrated!That is sooo unbelievable! He'll prescribe the Parnate but not the 'just in case' pill? (Is he the one prescribing the Parnate?) That seems highly irregular and dangerous. If he's so uncomfortable prescribing the emergency pill he shouldn't be prescribing Parnate!
-Jessica
(Please correct me if I'm wrong.)
Posted by LLL on July 22, 2002, at 12:00:07
In reply to Re: MAOI diet short list » LLL, posted by jsarirose on July 22, 2002, at 11:55:11
My Psych. is the one prescribing the Parnate and not the antidote and pushing me off on my G.P. Yep, I agree it's her responsibility! I have no other psych. to turn to right now and am just plain stuck! I asked my G.P. if he'd call her and talk some sense into her and I'm awaiting a reply.
Thanks,
Lisa
so glad to hear peanut butter's OK!!!! :-)
Posted by cybercafe on July 22, 2002, at 13:29:19
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 10:53:52
>acceptable in small doses if the total effect could give you a reaction. And, how long does it take to clear your system of tyramine. For example, if I had a bunch of coffee in the morning, could I have a bunch more at night? Anyway: "Tyramine gets digested pretty quickly, and likely clears the gut in 12 hours or so."
i'm sure it must depend on how much there is to begin with...
.... if say 50% is metabolized after 30 min, you could probably get away with .... one half the max tyramine content every half hour.... or... 31% every fifteen minutes...
the half life of tyramine in a beverage must be much less than that in a solid since it can make it's way down the alimentary canal much more easily, and has a greater surface area and is more more easy to break down (being liquid) etc etc etc
Posted by Bobbiedobbs on July 23, 2002, at 23:01:32
In reply to Re: MAOI diet short list, posted by jsarirose on July 22, 2002, at 2:52:50
Re one poster's question about soy products, I spoke today with GlaxoSmithKline's expert (via a customer service rep) who said soy protein and soy flour are safe to eat to the extent that they are not "aged or fermented in any way." As to whether they are or not, they said I'd have to contact the soy products manufacturers. That leaves open the question. I suggested that the drug maker update their food list to reflect soy-based products. They (apparently) don't intend to, as there are too few people taking this product to justify the effort. I agree with Jessica's earlier post regarding soy and soy flour, Marsala wine in cooking and chicken broth made without yeast (all safe). But that's just my opinion.
The list published by Strong Memorial Hospital Pharmacists in 1998, which appeared on the Univ. of Rochester web site, said to "avoid" "soy sauce and other soybean condiments" but that "soy milk" was specifically "allowed." It also said that no more than 4 ounces of wine per day was OK. Another site says you can consume a "moderate" (defined as 1/4 to 1/2 cup total per day) of the TOTAL of a wide array of items, including, among others: buillon, commercial breads without or low in yeast, MSG, and terriyaki sauce (which it specifically limits to 2-4 tbsp a day).
One poster requested the address to get a copy of the University of Toronto study - which I believe is the most definitive to date on MAOs. I don't know if this is still a good address, but in 1996, I wrote to Kenneth I. Shulman MD, Dpt. of Psychiatry, Sunnybrook Health Science Center, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5 and received a detailed response to my questions. The phone (again back in 96) was 416-480-4079. The name of the study is, "The Making of a User Friendly MAOI Diet," by David Gardner, Kenneth Shulman, Scott Walker and Sandra Tailor. Reprint requests to: Kenneth Shulman, M>D. S.M. F.R.C.P. (C), Dept. of Psychiatry, and the rest as above. This diet says that MSG, soy milk and yeast extracts except Marmite are fine but to avoid soy sauce and soy condiments. It goes into enormous detail. They studied )a) how much tyramine was actually in a variety of food products and (b) whether there has actually been any documented instances of reactions to any of the no-nos. Conclusion: ""Many MAO diets are excessively restrictive and without solid science." For those who drink or want to drink beer and alcohol, there's a second study that lists the amount of tyramine in hundreds of beers. It is called, "Hypertensive Episode Associated with Phenelzine and Tap Beer...". available at the same address from Sandra Tailor. Everything was fine except a bottle of Kronenbourg on tap (horror show) and tap versions of Upper Canada Lager and Rotterdam Lager. None of the bottled or canned beers presented any problem. The conclusion was that it is not the alcohol, but the process in which certain tap is made - a secondary fermentation process which apparently allows bacterial growth and tyramine production. This process does not occur in the popular, bottled beers.
Sunnybrook Health Science Center's MAOI Diet, which I generally follow, says to avoid all cheese except fresh cottage cheese, cream, ricotta, processed cheese slices, and allows no more than 2 domestic bottled or canned beers (including nonalcoholic) or 4 fluid ounces glasses of red or white wine per day.
Phil
Posted by Bobbiedobbs on July 23, 2002, at 23:21:15
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
Can't resist one more stab at the TV dinner issue (I believe they are now referred to as "frozen dinners."). I did a more careful estimate and figure I have consumed approximately 4,000 frozen dinners, the great majority of them which listed autolyzed yeast, etc., among their ingredients, without THE SLIGHTEST reaction. This on up to 60 mg. of Nardil and 50 mg. of Parnate. Not to be glib, but I'd worry more about the chemical soup in the frozen dinners generally.The frozen dinners help me with portion control, plus they are better than anything I could cook without alot of effort - particularly most of the Lean Cuisine products.
Posted by jsarirose on July 23, 2002, at 23:22:21
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
It also said that no more than 4 ounces of wine per day was OK. Another site says you can consume a "moderate" (defined as 1/4 to 1/2 cup total per day)
> Sunnybrook Health Science Center's MAOI Diet, which I generally follow, says to avoid all cheese except fresh cottage cheese, cream, ricotta, processed cheese slices, and allows no more than 2 domestic bottled or canned beers (including nonalcoholic) or 4 fluid ounces glasses of red or white wine per day.
> PhilWith cheeses, don't take the lists provided as total - basically fresh cheeses (what they list) are fine, including mozzarella! If you're craving a cheese that melts, like I was, mozzarella is your friend! Plus, they seem to come out with new cheeses all time. I always find out if it's a "fresh" vs. aged cheese and go for it if I'm positive it's fresh. (Usually the white creamy cheeses.)
RE: soy sauce, I've seen numerous sites that say it's okay in limited amounts, no more than a tbsp. Since I've been fine on that, I see no reason to exclude it from my diet. (Personal choice.)
RE: alcohol. I have also ready varying amounts for red and white wines, and beer some more generous than others. I, personally, have interpreted this to be 'in moderation'. I have had as much as three glasses of red wine & champagne in an evening with no averse effects. I've also had three or so beers and been just fine.
The issue with beer, is as Bobbie said - the danger lies in possible moldy or unclean processes. That's why tap beer & homemade beer are no's, and some of the smaller microbrews are questionable and therefore taboo (in my mind). I also extrapolated this to mean the homemade wine my friend gave me should be totally off limits. (Didn't want to chance it.)
I've had all types of hard liquors, in moderation, with no adverse effects as well.
Please note: these are MY opinions and MY experiences, your mileage may vary.
-Jessica
Posted by jsarirose on July 23, 2002, at 23:26:06
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
I have a new question that I haven't been able to get answered:
I've had numerous (legal) fresh mushrooms, many types of wild, with no ill effect. And I wouldn't expect any.
I'm wondering about dried mushrooms, for instance, shitakes often come dried. I don't think they are technically aged so they should be okay, but sometimes they look like they've been around a while. Any idea if they're okay? Any guesses on whether you think they would be okay?
-Jessica
Posted by LLL on July 24, 2002, at 8:47:26
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
My heartfelt thanks to you both for these 3 posts.
Lisa
Posted by LLL on July 24, 2002, at 9:28:58
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 23, 2002, at 23:22:21
Somehow my prior thread got mixed up with someone commenting on mood disorders. Want to thank you both, Jess and Phil, for being so very helpful and patient. As my anxiety subsides y'all will here from me less. Promise!
Lisa
Posted by jsarirose on July 24, 2002, at 14:03:55
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by LLL on July 24, 2002, at 8:47:26
> My heartfelt thanks to you both for these 3 posts.
> LisaAbsolutely no problem! That's what these lists are for - sharing information. And I know from my own struggles with trying to get a grasp of the intricacies of the "diet" that it takes a while to really understand it. Soon you'll be able to make your own educated decision on many items.
Of course, we all need to post questions from time to time - hence my question about dried mushrooms.
Take care,
Jessica
Posted by cybercafe on July 24, 2002, at 16:26:22
In reply to Re: MAOI diet short list, posted by Bobbiedobbs on July 23, 2002, at 23:01:32
Hey thanks a lot Philthey are quite good there -- not only do they answer their phone lines, but apparently i can go down there and pick up a copy for free...
i'm just wondering though.. does it list the tyramine content of different brands of soy sauce ?
btw - yes it's still the correct phone no for Dr. Shulman's secretary
hmmm... actually the 1999 report seems interesting too:
Refining the MAOI Diet: Tyramine Content of Pizzas and Soy Products
Kenneth I. Shulman, M.D., S.M., F.R.C.P.(C)., and Scott E. Walker, M.Sc.Pharm.(J Clin Psychiatry 1999;60:191Ð193)
--------------------------------------------------------------------------------Received March 22, 1998; accepted June 30, 1998. From the Departments of Psychiatry (Dr. Shulman) and Pharmacy (Mr. Walker), University of Toronto, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Reprint requests to: Kenneth I. Shulman, M.D., Department of Psychiatry, Sunnybrook Health Science Centre, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada.
Posted by cybercafe on July 24, 2002, at 20:14:37
In reply to Re: MAOI diet short list » Bobbiedobbs, posted by jsarirose on July 24, 2002, at 14:03:55
i was talking with my doc about getting relief from the MAOI migraine and he confirmed something i've read concerning effects of noradrenergic receptors ... i.e. they have different effects at different locations in the body!... tyramine causes increased blood pressure by vasoconstriction ... however ... headaches are caused by vasodilation in the head -- blood vessels swell (dilate) and press against nerves ... (i thought we didn't have pain receptors in the head?) ...
so maybe that's why yous were saying nifedepine doesn't work on migraines??
Posted by SLS on July 25, 2002, at 7:22:38
In reply to Re: hypertensive experiences?, posted by ayrity on July 17, 2002, at 23:55:30
Hi Ayrity.
> I have atypical depression and extreme fatigue is the prominent symptom- since Parnate has a stimulant effect we went with that first. My doc prefers Marplan (fewer side effects, though knowing me...) instead of Parnate if the stimulant effect is not required, or as second choice if the Parnate doesn't work out.
I am very interested to know why your doctor would choose Marplan over Nardil. Marplan is most definitely more mild in terms of side effects. However, the "old-timers" characterized Marplan as being a "weaker Nardil". It's non-usage probably led to the drug company to discontinue it years ago. However, there are a significant number of people who respond well to Marplan whom failed to respond to both Nardil and Parnate. I think the drug company was convince to begin selling Marplan again after they received so many requests that it be made available under a "compassionate use" protocol.
Terrence Ketter, MD at Stanford has recommended to a friend of mine that he also prefers Marplan, although I don't know all of his reasons why.
Since Nardil has been so much help to me, I would most definitely want to know why your doctor chose Marplan for you. With Nardil, the most troublesome startup side effect has been severe orthostatic hypotension. I had to literally crawl on all-fours to and from the bathroom and crawl down the stairs backwards. Surely, Nardil is not known to produce episodes of spontaneous hypertension as does Parnate. However, Marplan is probably much less offensive in this regard.
Does your doctor feel that Marplan is as efficacious as Parnate and Nardil?. How does he characterize the advantages of Marplan regarding side effects? Perhaps Marplan has been underestimated in the past such that it can now be justified as a first choice among MAOIs.
I'll say a little prayer on your behalf.
Good luck.
Sincerely,
Scott
Posted by judy1 on July 25, 2002, at 11:09:35
In reply to Re: hypertensive experiences? » ayrity, posted by SLS on July 25, 2002, at 7:22:38
This has nothing to do with this thread, I just wanted your attention :-). I have a thread on Psycho-Psycho Babble (my symptoms on manic psychosis) where I mention your offer to e-mail you when I was getting manic. If you remember any of that, would you mind contributing? Thanks a lot! Now back to regular programming.... Take care, judy
Posted by jsarirose on July 25, 2002, at 13:46:50
In reply to Re: hypertensive experiences? » ayrity, posted by SLS on July 25, 2002, at 7:22:38
"Surely, Nardil is not known to produce episodes of spontaneous hypertension as does Parnate. "
Did you mean to say 'not known to' ? I'm not questioning you at all, I just wasn't aware that this difference existed. I thought people on Nardil had to adhere to the same diet restrictions as those on Parnate and that the same risks were involved. How interesting.
-Jessica
Posted by LLL on July 25, 2002, at 13:50:19
In reply to Re: hypertensive experiences? » ayrity, posted by SLS on July 25, 2002, at 7:22:38
I'm unaware of Parnate causing "spontaneous increases in hypertentsion" without diet/drug violations. Can you please provide the source of your information?
Thanks
Posted by cybercafe on July 26, 2002, at 0:15:21
In reply to Re: hypertensive experiences? » SLS » SLS, posted by jsarirose on July 25, 2002, at 13:46:50
> Did you mean to say 'not known to' ? I'm not questioning you at all, I just wasn't aware that this difference existed. I thought people on Nardil had to adhere to the same diet restrictions as those on Parnate and that the same risks were involved. How interesting.i believe some people commented that parnate can react with it's own stimulant-type metabolites to cause a spontaneous hypertensive crisis? though i imagine this must be quite rare
Posted by cybercafe on July 26, 2002, at 0:21:14
In reply to Re: hypertensive experiences? » ayrity, posted by LLL on July 25, 2002, at 13:50:19
well i went down to sunnybrook today and picked up a copy of "tyramine content of pizzas and soy products" ... it does list the tyramine content of 5 different soy sauces, which isn't too bad...jess: which soy sauces have you tried in the past? ... and were they fresh, or restaurantish?
i am wondering if the "tyramine content in chinese food", Wing Y-K, Chen C-N, journal clinical psychopharmacology 1997, might have yet even more information, but i can't seem to find a copy online .........
.... it would be nice if someday soon, like everyone else, i were to educate myself in matters that actually helped to generate money :)
Posted by jsarirose on July 26, 2002, at 1:41:09
In reply to Refining the MAOI Diet, posted by cybercafe on July 26, 2002, at 0:21:14
>
> jess: which soy sauces have you tried in the past? ... and were they fresh, or restaurantish?
>
> i am wondering if the "tyramine content in chinese food", Wing Y-K, Chen C-N, journal clinical psychopharmacology 1997, might have yet even more information, but i can't seem to find a copy online .........I've had different types of soy sauce, from the ones in restaurants to store bought (cheap & expensive like Tamari). Haven't had a problem with any. In a restaurant if I'm eating something that has soy sauce in it I don't tend to add more - but that's more of a taste preference than being worried about tyramine.
Was there a big difference in the five soy sauces tested?
I also don't know if there could ever be a difinitive listing of tyramine content in chinese food. Restaurants vary so much as to the way they make similar dishes.
-Jessica
Posted by LLL on July 26, 2002, at 9:04:34
In reply to Refining the MAOI Diet, posted by cybercafe on July 26, 2002, at 0:21:14
In the literature you picked up does it say anything about soy protein - like in soy burgers?
Posted by cybercafe on July 26, 2002, at 10:43:36
In reply to Re: Refining the MAOI Diet, posted by jsarirose on July 26, 2002, at 1:41:09
>with any. In a restaurant if I'm eating something that has soy sauce in it I don't tend to add more - but that's more of a taste
oh wow i didn't know that you ate food with soy sauce already in it, .... sounds risky ... :(
... one tbsp (15mL) had results as follows
wing's 0.1483 mg tyramine
kimlan 0.5496 mg
ozeki sashimi 1.2488
pearl river bridge 3.3652
kikkoman 0.4351so as you can see there is a lot of variability... they in fact state "We conclude that all soy sauces and indeed all soybean products should be avoided".
.... but i feel that if you can get away with 15 mL on 100 mg, i should be able to on 30 mg :)
> Was there a big difference in the five soy sauces tested?
> I also don't know if there could ever be a difinitive listing of tyramine content in chinese food. Restaurants vary so much as to the way they make similar dishes..... yeah... at least if you are going to risk it, you have some guidance as to which to try and which to avoid....
i mean when one brand has about 30 times the content of another, it may be quite useful to be discriminating by brand...
i'm quite happy that kikkoman is one of the better brands....it's also interesting that different things age at a different rate in terms of tyramine production... but i'll save that for the next message
btw how are you doing jess?
>
> -Jessica
Posted by cybercafe on July 26, 2002, at 10:50:45
In reply to Re: Refining the MAOI Diet, posted by LLL on July 26, 2002, at 9:04:34
> In the literature you picked up does it say anything about soy protein - like in soy burgers?
"vita tofu" 300 g goes from 0.2268 mg to 4.7914 mg of tyramine if stored 7 days in refrigerator (4 degrees C)...
one veggie burger after 7 days in the fridge
100 g had 0.0628 mg of tyramine, 2 days later, the level went up to 0.5983 mg of tyramine ...
so i take it freshness is quite important ...
... basically today you could eat two burgers and have no effect, the next day you could eat half of a burger and really have a lot of trouble
but they only seemed to have tested one type that i can tell.... so if i were to risk it, i would probably stick to one brand, and at first start out by eating one bite every hour or so and taking my blood pressure.... or does tyramine show an effect on bp faster than that?
then again, how relevent is it how long it has been stored in the grocery store? ....have you guys heard anything about soy burgers?
Posted by jsarirose on July 26, 2002, at 14:22:31
In reply to Re: Refining the MAOI Diet, posted by cybercafe on July 26, 2002, at 10:50:45
>
> have you guys heard anything about soy burgers?Keep in mind that soy is not inherently bad, it's some forms of soy. Anything aged (soy sauce, tempeh, ...) is either not allowed or allowed in moderation (depending on item). So if you read the ingredients and it's simply soy or soy bean, etc. and it's not aged - it should be just fine. I eat a lot of soy products as I'm increasingly eating vegetarian and I've had no problems. If I'm unsure, I don't buy it and/or try to find out whether it's aged.
-Jessica
Posted by SLS on July 26, 2002, at 14:23:48
In reply to Re: hypertensive experiences? » SLS » SLS, posted by jsarirose on July 25, 2002, at 13:46:50
> > Surely, Nardil is not known to produce episodes of spontaneous hypertension as does Parnate. "
> Did you mean to say 'not known to' ? I'm not questioning you at all, I just wasn't aware that this difference existed. I thought people on Nardil had to adhere to the same diet restrictions as those on Parnate and that the same risks were involved. How interesting.
Hi Jessica.First of all, it would be very silly of you not to question me. :-)
It is true that I have never been wrong, though. One time I thought I was wrong, but it turned out that I was mistaken.
There's a joke in there somewhere.
I'm glad you replied the way you did. Others may have also misinterpreted what I said, which of course is dangerous. I wish that I had the good sense to better clarify my statement.
The key word in my post is "spontaneous". For some people, Parnate can cause high blood pressure spikes all by itself. They don't have eat anything for this to happen. It is thus spontaneous. This is what was being referred to in the post I replied to. To the best of my recollection, I have never seen this happen at all with Nardil.
Of course, both of these MAOIs, along with Marplan, are capable of producing a dangerous hypertensive reaction to the foods and drugs that are to be avoided.
Is my post still confusing?
- Scott
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