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Dr. Bob is Robert Hsiung, MD,
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Posted by LLL on September 8, 2002, at 16:24:50
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 8, 2002, at 15:57:19
Good Luck Jessica! Sorry I won't be able to experiement with foods with you since I've dropped out of the MAOI club and joined the Benzo club!
Posted by utopizen on September 8, 2002, at 16:27:38
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 8, 2002, at 15:57:19
Soya and tofu aren't the same thing. Tofu is processed soya (or "soy").
That would like calling milk and cheese the same thing. Yeah, they're both dairy, but one's processed.
Posted by Bobbiedobbs on September 8, 2002, at 18:41:25
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 8, 2002, at 15:57:19
Jessica: The list to which I was referring is from a separate report, "Refining the MAOI DIET: Tyramine Content of Pizzas and Soy Products" by Kenneth I. Shulman M.D and Scott Walker, M.Sc.Pharm (3/1999) and a subsequent report, "A reevaluation of Dietary Restrictions for Irreversible MAOs" by the same guys, dated 06/2001. I don't know if this was ever posted online but I learned of it from one of the prior posters and got it by mail. Per that report, the bottom line on some of the foods in question is:
Foods with per serving/tyramine content well below the conservative 6 mg/serving danger level:
Sargento Light Italian, Aged Romano cheese, Ziggy's feta cheese (like that name!) and mozzarella. In the pizza category: double cheese/double pepperoni pizzas from Domino's, Pizza Pizza, Pizza Hut and McDonalds; three common Worcestershire sauces. Of 5 soy sauces tested, only Pearl River Bridge soy sauce presented any problem. They tested a whole mess of wines, all of which registered tyramine levels well below concern (you'd have to have 12 servings of the worst of them - a Spanish red - to reach a level of concern. The Chiantis that were tested didn't prove to be a problem.
Yes, I'm interested in you being the king's tester for the cheeses mentioned in the other report which Lisa reposted, within safe and reasonable limits (whatever the hell those are!)As for beers, I can't say that I have tried them all but I have had a whole slew of the bottled and canned beers tested, with nary a reaction (MAO reaction that is). Phil.
Posted by jsarirose on September 8, 2002, at 19:02:32
In reply to Re: MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 8, 2002, at 18:41:25
> Jessica: The list to which I was referring is from a separate report, "Refining the MAOI DIET: Tyramine Content of Pizzas and Soy Products" by Kenneth I. Shulman M.D and Scott Walker, M.Sc.Pharm (3/1999) and a subsequent report, "A reevaluation of Dietary Restrictions for Irreversible MAOs" by the same guys, dated 06/2001.
Oh, I don't think I saw that one. I haven't had a fear of pizza at all. The only chain I know that uses an unacceptable cheese mix is Godfather's. They have cheddar in the mix. Other than that - I eat pizza as much as I want. (I do make sure I know what cheeses they use on the pizza though.) I also eat parmesan and romano cheeses. I don't over do it, but then it's hard to eat a whole ton of those cheeses anyway. I was wary about parmesan, but since I always ate a little, I recently upped the amount and still had no effect. Then I started reading that it's an okay cheese in moderation. So I guess those items were never really an issue with me.
-Jessica
Posted by cybercafe on September 9, 2002, at 8:08:55
In reply to Re: MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 8, 2002, at 18:41:25
bobbiedobs >> what is covered in "A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors"?
i am actually thinking of dropping by sunnybrook today anyway, their library sells used medical textbooks for like $10 (Shhhhhhhhhhh!!)
Posted by Bobbiedobbs on September 9, 2002, at 13:24:01
In reply to Re: MAO cheese, soy, etc followup, posted by cybercafe on September 9, 2002, at 8:08:55
Not much new if you have seen their previous studies. It summarizes the findings of all of their studies. It provides results of a survey on current attitudes among psychiatrists toward MAOIs and a discussion of the authors' testing methodology and benchmark as to what is considered "safe".
The only thing I hadn't seen was a table listing tyramine content of 11 wines and another table assigning qualitative rankings to the evidence for restrictions of various foods.
Posted by jsarirose on September 10, 2002, at 3:05:32
In reply to Re: MAO cheese, soy, etc followup » cybercafe, posted by Bobbiedobbs on September 9, 2002, at 13:24:01
Swiss Gruyere! And no problem. Yummmm - haven't had flavorful cheese in sooo long. Tomorrow I'm on to the Muenster. I didn't have a ton of the cheese, but I had enough to see if there was a reaction and there wasn't even a trace. I'm not going to worry about that one anymore.
-Jessica
Posted by jsarirose on September 11, 2002, at 1:03:02
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 10, 2002, at 3:05:32
> Swiss Gruyere! And no problem. Yummmm - haven't had flavorful cheese in sooo long. Tomorrow I'm on to the Muenster. I didn't have a ton of the cheese, but I had enough to see if there was a reaction and there wasn't even a trace. I'm not going to worry about that one anymore.
>
> -JessicaOkay - and Muenster cheese was just fine too. I do take the precaution of cutting off the edges as they sometimes have mold on them. But other than that - no reaction at all. I guess brie (without the rind) will be my next try! (But I need to finish what I bought first.)
-Jessica
Posted by Bobbiedobbs on September 15, 2002, at 14:58:41
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 11, 2002, at 1:03:02
Jessica - thanks for the trial tests! How large an MAO doseare you taking? I used to be quite a cheese devotee before the MAO era. I plan to try these cheeses (as well possibly as the Kraft mac and cheese) also. Those cheeses are technically considered fresh and soft, although they can have a bit of a bite - so the lack of a prohibition makes sense. It 's great that we have a peer group on the drugs but unfortunate that better info is not available from the doctors and drug company. Phil
> Okay - and Muenster cheese was just fine too. I do take the precaution of cutting off the edges as they sometimes have mold on them. But other than that - no reaction at all. I guess brie (without the rind) will be my next try! (But I need to finish what I bought first.)
>
> -Jessica
Posted by jsarirose on September 15, 2002, at 15:50:46
In reply to Re: MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 15, 2002, at 14:58:41
> Jessica - thanks for the trial tests! How large an MAO doseare you taking? I used to be quite a cheese devotee before the MAO era. I plan to try these cheeses (as well possibly as the Kraft mac and cheese) also. Those cheeses are technically considered fresh and soft, although they can have a bit of a bite - so the lack of a prohibition makes sense.
I'm currently down to 50mg (I was up to 100mg) - that could effect the effect! However I've had no reaction whatsoever and I've eaten a fair amount at a time. The Gruyere was especially exciting for me as I have had a good, sharp, hard cheese in ages. I believe the inside of brie (not the rind) is okay too, but I haven't tried that yet. So, eat with joy! (Hopefully I'm not an anomoly.)
And yes, I wish my doctor was more knowledgable, but I guess she can't know everything in depth. Especially when MAOIs aren't prescribed very often anymore. I try to update her on what I find so she can pass it on to other patients. I've learned much more from the web and user groups than I have from her (about Parnate).
-Jessiac
Posted by cybercafe on September 16, 2002, at 1:02:03
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 15, 2002, at 15:50:46
bobbiedobs >> i think LostBoyInNC had some macaroni and cheese on a really low dose, like 20 mg, and had a hypertensive crisis
strange eh?
> > Jessica - thanks for the trial tests! How large an MAO doseare you taking? I used to be quite a cheese devotee before the MAO era. I plan to try these cheeses (as well possibly as the Kraft mac and cheese) also. Those cheeses are technically considered fresh and soft, although they can have a bit of a bite - so the lack of a prohibition makes sense.
>
> I'm currently down to 50mg (I was up to 100mg) - that could effect the effect! However I've had no reaction whatsoever and I've eaten a fair amount at a time. The Gruyere was especially exciting for me as I have had a good, sharp, hard cheese in ages. I believe the inside of brie (not the rind) is okay too, but I haven't tried that yet. So, eat with joy! (Hopefully I'm not an anomoly.)
>
> And yes, I wish my doctor was more knowledgable, but I guess she can't know everything in depth. Especially when MAOIs aren't prescribed very often anymore. I try to update her on what I find so she can pass it on to other patients. I've learned much more from the web and user groups than I have from her (about Parnate).
>
> -Jessiac
Posted by jsarirose on September 16, 2002, at 1:23:54
In reply to Re: MAO cheese, soy, etc followup, posted by cybercafe on September 16, 2002, at 1:02:03
> bobbiedobs >> i think LostBoyInNC had some macaroni and cheese on a really low dose, like 20 mg, and had a hypertensive crisis
>
> strange eh?
>My understanding is only something like Kraft Macaroni & Cheese is acceptable. It has to be the processed type cheese (and whatever else they do to it). I wouldn't recommend eating anything remotely related to real cheese in Mac & Cheese. I wonder what brand and style LostBoy tried?
-Jessica
Posted by Bobbiedobbs on September 18, 2002, at 0:04:50
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 16, 2002, at 1:23:54
Thanks for the warning, cyber. Kraft it is. I guess one advantage of processed food is that it's not completely real so even we can eat it with impunity. I had a TV dinner the other night that listed "water" and "(beef) binders" as it's top two ingredients. Yummy.
Jessica, what is parnate like up in the 60 plus stratosphere. The most I've gotten to is 50 mg. I find it hard to stay asleep and a bit more revved up at the higher levels, although I had experienced that at lower doses also, until I acclamated.
Posted by jsarirose on September 18, 2002, at 0:42:39
In reply to Re: MAO cheese, soy, etc followup, posted by Bobbiedobbs on September 18, 2002, at 0:04:50
> Jessica, what is parnate like up in the 60 plus stratosphere. The most I've gotten to is 50 mg. I find it hard to stay asleep and a bit more revved up at the higher levels, although I had experienced that at lower doses also, until I acclamated.
I'm definitely struggling since I lowered to 40mg. When I was at 100mg I felt pretty great. The best I'd felt in years and years. As I passed 60mg the positive effect just kept increasing. I stopped at 100mg because that was the point at which I could handle the med without being too dizzy. For sleep I take trazodone. I absolutely can't sleep if I don't take anything to help! I would still occasionally cycle in my sleep patterns where I would have trouble sleeping for several days and then crash. But if I regularly took Trazodone it wasn't as bad.
To counteract the dizziness I just split the dose into three times a day. The only problem I would have is if I missed my first dose by more than an hour or so. Then I'd be dizzy and tired for a bit.
The only reason I'm not still at 100mg is because I was trying to taper onto Lamictal and come down in the Parnate. But after I started doing that I started running low on meds and my new insurance only covers 50%. And 50% is still too expensive. So, until I can afford it - I'm at 40mg Parnate, 0 Lamictal. And starting to struggle again depression-wise.
-Jessica
Posted by cybercafe on September 18, 2002, at 13:00:24
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 18, 2002, at 0:42:39
> I'm definitely struggling since I lowered to 40mg. When I was at 100mg I felt pretty great. The best I'd felt in years and years. As I passed 60mg the positive effect just kept increasing. I stopped at 100mg because that was the point at which I could handle the med without being too dizzy. For sleep I take trazodone. I
Hmm... so at 50 or 60 mg you found you weren't depressed. But if you increase more, not only are you not depressed, but you feel better and better? Hmm.. what does that feel like? :)
So a psychiatrist should/will not consider it a success if we are just free from symptoms of depression, but we should also be feeling pretty good too? because this is how normal people feel?
I never considered that
Posted by cybercafe on September 18, 2002, at 13:20:20
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 18, 2002, at 0:42:39
btw... what is the absolutely most safest form of alcohol to have with an MAOI?
Posted by jsarirose on September 18, 2002, at 13:46:16
In reply to Re: MAO cheese, soy, etc followup, posted by cybercafe on September 18, 2002, at 13:00:24
> Hmm... so at 50 or 60 mg you found you weren't depressed. But if you increase more, not only are you not depressed, but you feel better and better? Hmm.. what does that feel like? :)
>I would say less depressed, not free from depression. For me feeling better means feeling more energetic, more optimistic, more social, less compulsive (mostly regarding food & money), and more willing/able to benefit from a good (emphasize "good") therapist.
> So a psychiatrist should/will not consider it a success if we are just free from symptoms of depression, but we should also be feeling pretty good too? because this is how normal people feel?
>
> I never considered that
>
My psychiatrist wouldn't consider me completely healed unless I were basically symptom free and able to work full-time again. Since I was still have some problems at 100mg and I had major acne as a side effect, we decided to try augmenting the Parnate to try to boost the positive effect and perhaps allow me to lower the dose somewhat. Although it was better than I'd felt for most of my life, it wasn't necessarily what "normal" people feel. And I did realize, no matter how perfect the drug, I would still need some psychotherapy. But if the drug is working well, I'm more receptive to therapy and get more out of it. My hope is that at some point I would be able to be off drugs. I no longer accept it as a given that I'll be taking something for the rest of my life. Of course since reducing my dosage and feeling worse, it makes me a bit more discouraged. It's amazing that when you feel better your suddenly question whether it really is the drug that's doing it or if it's changes you've made in your life and attitude. It's always a struggle.Okay - guess I'm a bit wordy today. Sorry.
-Jessica
Posted by jsarirose on September 18, 2002, at 13:55:58
In reply to Re: MAO alcohol followup, posted by cybercafe on September 18, 2002, at 13:20:20
>
> btw... what is the absolutely most safest form of alcohol to have with an MAOI?I think that's a little hard to answer since some forms vary in their tyramine content. For example, beer can be from 2 - 11. 2 would be very safe, but 11 would be dangerous. I think the tap beers/home brews would be closer to 11, and the bottled, fresh, beers would be closer to 2.
Champagne, white wine, and red wine seem to have low values and be safe as well. (0.3 - 2.4)
The clear liquors are lower than the colored (aged) liquors. For example vodka & gin are probably safer than bourbon or scotch or something aged. Basically you want to stay away from aged liquors if you are going to have quite a bit.
Personally I've had quite a bit to drink on occasion with no ill effects (from the Parnate, that is). The most I've had while on Parnate is probably 8 shots of vodka, 10 shots of rum and 6 shots of bourbon (although it's aged, it didn't seem to effect me). Now these amounts were over the course of an evening.
I've also found my tolerance for alcohol to be much lower than previously. So it doesn't take as much for me to feel tipsy or drunk. I also don't have as great a desire to drink.
Hope that helps a little. Maybe someone knows of a tyramine content list that's more extensive.
These are the pages I looked at: http://www.vh.org/Providers/Conferences/CPS/19.html
http://www.migraene.dk/Engelsk/triggers/Tyraminmigr%C3%A6ne-english.htm-Jessica
Posted by jsarirose on September 18, 2002, at 14:00:48
In reply to Re: MAO alcohol followup, posted by jsarirose on September 18, 2002, at 13:55:58
So one the very latest list (http://www.vh.org/Providers/Conferences/CPS/19.html)
it says that smoked fish is okay. Does anyone know if that means smoked salmon, trout, chubb, etc. are okay? I mean, I guess so. I'm also guessing lox is still out as it's smoked/cured a slightly different way. Maybe the difference is if it's fresh smoked vs. smoked & cured.Has anyone been eating smoked fish while on Parnate or Nardil? What kind?
Thanks,
Jessica
Posted by Bobbiedobbs on September 18, 2002, at 22:50:40
In reply to Re: MAO followup - Another Question, posted by jsarirose on September 18, 2002, at 14:00:48
> it says that smoked fish is okay. Does anyone know if that means smoked salmon, trout, chubb, etc. are okay? I mean, I guess so. I'm also guessing lox is still out as it's smoked/cured a slightly different way. Maybe the difference is if it's fresh smoked vs. smoked & cured.
Regarding 3 issues raised within the past day:
1) smoked fish - My only experience is salmon jerky (in Michigan), without any ill effect.
2) Regarding alcohol, I've consumed enough white wine to actually have passed out on several occasions 5-10 years ago without any seeming effect; I was taking 30-60 mg of Nardil at the time. This is not by way of boasting. I find that these days I am much more alcohol-sensitive (it affects me more), whether that is because of the Parnate or aging I'm not sure.
3) Re MAO dose. I generally find some freedom from social inhibition/anxiety at the mid-range MAO levels. I was often euphoric at 60 mg of Nardil. That period was probaby the best time of my life professionally, socially and romantically. But I eventually grew overly sensitive to the side effects and switched to Parnate. I don't real feel "great" at any level (my doctor will only let me go up to 40 mg) but I do get some relief from anxiety and depression. My drug-prescriber (who is not my therapist) basically is disdainful of MAOs - particularly Nardil - and won't prescribe more than 50 mg. Parnate. Jessica, sounds like you prospered at the higher level but the $ and other stuff got in the way. It's such a luxury not to have to avoid people all of the time and feel so stymied in "social" (i.e. people situation). When I was taking Nardil I actually was engaging and looked forward to some social situations. Phil.Has anyone been eating smoked fish while on Parnate or Nardil? What kind?
>
> Thanks,
> Jessica
Posted by cybercafe on September 18, 2002, at 23:57:12
In reply to Re: MAO cheese, soy, etc followup, posted by jsarirose on September 18, 2002, at 13:46:16
thanks for the descripted post jess, much appreciated
btw i think i have an email of yours i forgot to reply to, sorry, at first i put it aside so as to not annoy you, then i increased my dose of gabapentin, and became somewhat sane/social/optimistic ... i think i've actually got myself an awesome part time job ...
i don't know what to think about fulltime work .... i mean i could get a degree in pharmacy and work 20 hours a week and earn a good $2400 a month .... if things were really bad i could work in an all night pharmacy and relax... but theoretically when i become well i might actually want to work 8 hours a day, god, i can't imagine what that would feel like so it is so hard to plan... i hope i don't become too sane :)
Posted by jsarirose on September 19, 2002, at 0:38:53
In reply to Re: MAO cheese, soy, etc followup, posted by cybercafe on September 18, 2002, at 23:57:12
> i don't know what to think about fulltime work .... i mean i could get a degree in pharmacy and work 20 hours a week and earn a good $2400 a month .... if things were really bad i could work in an all night pharmacy and relax... but theoretically when i become well i might actually want to work 8 hours a day, god, i can't imagine what that would feel like so it is so hard to plan... i hope i don't become too sane :)
>
>Sounds like the med is actually working for you! Optimism is the first positive effect I think. Even contemplating normalcy is a great step in the right direction. Just go slow, and take one step at a time!
-Jessica
Posted by ayrity on September 19, 2002, at 23:50:18
In reply to Re: MAO followup - Another Question, posted by jsarirose on September 18, 2002, at 14:00:48
Hi:
I accidentally ate smoked salmon when I first started on Parnate (I was on 30 mg at the time). A few hours later, like a lightbulb switching on, I thought "Oh, sh**, I wasn't supposed to eat that!" Nothing happened, but I wouldn't try it again.I'm still quite scared to try any cheese and don't plan to do so in the near future, especially since I've already had a lot of BP problems.
Interestingly, the spontaneous hypertension I was having after a dose (unrelated to food) seems to be getting better. We've gone up on my dose very gradually- I've just started 70 mg this week. Sleep is a nightmare (pun intended)- Trazadone helps a bit, but leaves me feeling washed out the next day. Sonata did nothing for my sleep. I have a bit of dizziness sometimes when I stand too quickly, but not troublesome and otherwise very few side effects so far. I haven't noticed much benefit yet, though. If anything, I feel more withdrawn and antisocial, though more content and less depressed about being alone, if that makes sense.
> Has anyone been eating smoked fish while on Parnate or Nardil? What kind?
>
> Thanks,
> Jessica
Posted by jsarirose on September 20, 2002, at 0:10:10
In reply to Re: Smoked fish, and my update, posted by ayrity on September 19, 2002, at 23:50:18
> Interestingly, the spontaneous hypertension I was having after a dose (unrelated to food) seems to be getting better. We've gone up on my dose very gradually- I've just started 70 mg this week. Sleep is a nightmare (pun intended)- Trazadone helps a bit, but leaves me feeling washed out the next day. Sonata did nothing for my sleep. I have a bit of dizziness sometimes when I stand too quickly, but not troublesome and otherwise very few side effects so far. I haven't noticed much benefit yet, though. If anything, I feel more withdrawn and antisocial, though more content and less depressed about being alone, if that makes sense.
>Wow - 70mg and no effect? I wonder if this is going to be the drug for you. I felt soemthing by 60mg or so, and the benefit increased as I increased the dose. I hope you start feeling a bit better soon.
Don't be too afraid of cheese. Some of the cheeses have basically no tyramine. I wouldn't worry about cream cheese, ricotta cheese, fresh mozzarella, chevre, montrachet, etc. You may be a little more wary with feta, brie, gruyere, muenster, etc.
Some people like Klonopin for sleep. I prefer the Trazodone personally, but I've tried Klonopin too. You may want to try it. I don't recommend Sonata or Ambien because they're real sleep medications that will build up in your system causing an addiction or need for increased dose. Klonopin can be addicting, but as a sleep aid I've never heard of it being so. (I guess some people take it as a street drug - always seemed strange to me.)
Anyway, good luck with the increases. If you feel too dizzy, try splitting the dose into three or so times per day.
-Jessica
Posted by ayrity on September 21, 2002, at 0:34:13
In reply to Re: Smoked fish, and my update, posted by jsarirose on September 20, 2002, at 0:10:10
Thanks for the reply and the advice, Jessica.
I guess there has been some beneficial effect. I feel a bit more talkative when I encounter people; I just don't feel like searching people out and I still feel very isolated. I likely have a bit of social anxiety, but my major problem is atypical depression, which has not responded to anything so far. I've failed a lot of meds, so there's not much left, so this better be the one to do it. I have an experienced pdoc who really knows his stuff and is a good guy, too; from the very beginning he hasn't pushed the meds on me, but we decide together what seems right. He has no problem pushing up the dose of Parnate further as long as the side effects and my BP are acceptible.
The dizziness has not been much of a problem so far, just a bit now and then when standing too quickly. I do divide the dose, btw (30 mg in the am, 20 at noon, 20 in the afternoon). Sleep is a major problem. I don't wan't something that might be addicting, so I don't know about Klonopin. I don't like the idea of putting even more drugs in my system (I have other medical issues as well that I won't get into), so sleep aids really turn me off, but I don't have much choice at the moment.
As far as cheese, well, I'll keep away for now. I'll give it a go in the future, if things work out with the Parnate.
Thanks again!
> Wow - 70mg and no effect? I wonder if this is going to be the drug for you. I felt soemthing by 60mg or so, and the benefit increased as I increased the dose. I hope you start feeling a bit better soon.
>
> Don't be too afraid of cheese. Some of the cheeses have basically no tyramine. I wouldn't worry about cream cheese, ricotta cheese, fresh mozzarella, chevre, montrachet, etc. You may be a little more wary with feta, brie, gruyere, muenster, etc.
>
> Some people like Klonopin for sleep. I prefer the Trazodone personally, but I've tried Klonopin too. You may want to try it. I don't recommend Sonata or Ambien because they're real sleep medications that will build up in your system causing an addiction or need for increased dose. Klonopin can be addicting, but as a sleep aid I've never heard of it being so. (I guess some people take it as a street drug - always seemed strange to me.)
>
> Anyway, good luck with the increases. If you feel too dizzy, try splitting the dose into three or so times per day.
>
> -Jessica
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