![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by H. Upmann on August 1, 2006, at 20:53:57
Hello,
I'm new to this board, but am glad to have stumbled upon it. I have a question that no one can seem to answer. I am going to start taking Nardil (MAOI), and I also like to lift weights which requires increased protein supplementation. Is it safe to use a protein powder (i.e. whey protein concentrate/isolate) with Nardil? Whey protein is a complete protein much like whole eggs are. It will have the same amino acid profile to include tyramine, phenylalanine, and l-tryptophan. My doctor says I can eat all the eggs and chicken I want, but no protein powders. My question is what is the difference? They both have similar amino acid profiles, and assuming these are fresh and obviously not aged proteins why would it be a problem? I know tryptophan is contraindicated with MAOI's, but turkey is certainly not excluded from the dietary restrictions although it contains high levels of tryptophan. Can anyone tell me why a protein powder by itself with no additional ingredients (herbs or stimulants) would be a problem? I've called several Walgreens and they just regurgitate what the computer spits out for Nardil and contraindications. I need someone with some knowledge on this to speak up if they have time.
I also smoke the occasional cigar that is aged tobacco. Obviously I don't eat the cigar or inhale, but is it still a risk to smoke the occasional cigar? Would there be any appreciable amount of tyramine in the smoke itself? If you have an answer for either of these questions I'd be most grateful. Nobody seems to know. The pdoc told me I probably know more about this archaic med than he does, (how reasurring is that?!?), and he couldn't say for sure on the protein powder except of course the disclaimer to avoid it anyways. If you know the answer I will fricken pay you for it. Please help me out with this if you have the knowledge and opportunity. Thanks for your time.
H. Upmann
Posted by Declan on August 1, 2006, at 21:59:55
In reply to MAOI and protein powder, posted by H. Upmann on August 1, 2006, at 20:53:57
Is it the case that if the protein is hydrolysed the amino acids are in the free form?
Some protein powders (Musashi) have free form amino acids added, I think. You'd have to be careful with those.
Could you use protein powder to augment MAOIs?
Posted by Phillipa on August 1, 2006, at 22:19:26
In reply to Re: MAOI and protein powder, posted by Declan on August 1, 2006, at 21:59:55
Same question I drink a whey protein powder too . It helps my hair grow. And I supplement a meal every now and then with it. And I take an MVI and ester C and calcium and magnesium any problem with those on EMSAM? Love Phillipa
Posted by H. Upmann on August 1, 2006, at 22:42:30
In reply to Re: MAOI and protein powder, posted by Phillipa on August 1, 2006, at 22:19:26
Thanks for the responses. I know Ensam (selegiline) is a bit different MAOI. Especially with restrictions. I'm just talking about a simple whey protein powder with isolates and hydrolysates. I don't know what the difference is between the amino acids found in a powder vs. those found in whole food protein sources. I don't know why it would be a big deal. Apparently these MAOI's are so ancient it seems a lot of research and interest has been abandoned. This is unfortunate since this class of drugs (which is so underprescribed and avoided) seems to really be a beneficial if not life changing med for a few people who are non-responsive to most meds. Thanks again for the replies. If anyone can clear up this question I will no kidding cut you a check. I really would like to know with some scientific basis why I can't have a protein powder, but I can eat all the chicken, steak, tuna, etc., I want. These all have the same amino acid profiles to a certain extent and as such will include quantities of tryptophan, tyramine, and phenylalanine. I just don't get it. Thanks again though. H. Upmann
Posted by Jost on August 1, 2006, at 22:42:54
In reply to Re: MAOI and protein powder, posted by Declan on August 1, 2006, at 21:59:55
Which maoi are you taking, btw?
Smoking-- not a problem. Not sure what you;re worried about there.
Whey protein can often have hydrolized soy in it. Soy, depending on the form, can be dangerous. From the websites I checked, I'd say the type in at least some whey proteins must be of the type that can create a tyramine (or soy) reaction. Something about the process by which the whey is produced.
It's a question of how much tyramine is in any particular food. Turkey normally doesn't have a lot; aged cheese does. Many foods, when fresh, have a small amount, but with aging or spoiling, can have greater amounts. So if you have, say, chicken salad out for long periods of time on a hot day, you can end up with much greater amounts of tyramine than are in chicken kept cold.
It's actually more complicated than this-- but if you're starting on an maoi, I'd really stay on the safe side, until you know how you react to it. There's variation among people and until you;ve got some experience, I wouldn't do anything but adhere to the basic prohibitions.
Hope this helps.
Jost
Posted by jedi on August 1, 2006, at 22:52:27
In reply to MAOI and protein powder, posted by H. Upmann on August 1, 2006, at 20:53:57
...
It will have the same amino acid profile to include tyramine, phenylalanine, and l-tryptophan. My doctor says I can eat all the eggs and chicken I want, but no protein powders.
...Hi,
I've been taking Nardil for most of the past ten years. I would not take anything that lists tyramine as an ingredient as this is the substance that needs to be avoided on a MAOI diet. Tyramine is broken down in the gut by Monoamine Oxidase. If you inhibit this enzyme in the gut, with a medication such as Nardil, it can lead to a hypertensive crisis, possible stroke, and even death. Tyramine can be injested in very small quantities with no problem, but I would not take a chance unless I knew the exact quanity of tyramine in your protein powder.Here is a good list of foods you can eat and should avoid on Nardil.
Remember, everyone is a little different in their tolerance to tyramine.
MAOI diet short list
Posted by Elizabeth on August 17, 2001, at 13:43:12
http://www.dr-bob.org/babble/20010814/msgs/75408.htmlBy the way, sometimes when absolutely nothing else works, Nardil can bring depression to a screaching halt!
Good Luck,
Jedi
Posted by H. Upmann on August 1, 2006, at 22:53:05
In reply to Re: MAOI and protein powder » Declan, posted by Jost on August 1, 2006, at 22:42:54
Thanks Jost. I'll stick to the restrictions for now. This is simply whey protein. No soy involved and perhaps in the manufacturing (ion-exchange cold processing etc.,) something happens with the amines involved in making up the protein. I don't know, but will steer clear for now.
With regards to the smoking, a pharmacist from Walgreens mentioned that cigars (which would have aged tobacco) would carry these amines even if I didn't inhale. I don't see how that flies either. I really wish their was a genuine authority on MAOI's. I don't really know who to pose these questions to, although you all have been very helpful and I am indeed grateful. It's odd to continue manufacturing a med, but not update the restrictions. I know that Dr. Shulman I believe has a revised list and I have the link somewhere, but it doesn't mention protein powders. Perhaps it's just a grey area that nobody is comfortable giving advice in. Again, thank you all for your time, and if you care to add anything else it would be most appreciated. Thanks. H. Upmann
Posted by jedi on August 1, 2006, at 23:04:46
In reply to Re: MAOI and protein powder, posted by Phillipa on August 1, 2006, at 22:19:26
> Same question I drink a whey protein powder too . It helps my hair grow. And I supplement a meal every now and then with it. And I take an MVI and ester C and calcium and magnesium any problem with those on EMSAM? Love Phillipa
Hi Phillipa,
Emsam is different because it bypasses the gut. At its lowest dosage of 6mg you do not need to follow the MAOI dietary restrictions. At higher dosages you do.
Source:
https://www.mayoclinic.com/health/maois/MH00072
Take care,
Jedi
Posted by H. Upmann on August 1, 2006, at 23:05:34
In reply to Re: MAOI and protein powder » H. Upmann, posted by jedi on August 1, 2006, at 22:52:27
Thanks Jedi,
I'm starting the Nardil for extreme social anxiety with a bit of depression as a result of the anxiety. I've tried every concievable med for anxiety - all SSRI's, SNRI's, Remeron, Wellbutrin, Serzone, tri-cyclics, benzos, anti-convulsants, you name it. Nardil apparently is the gold standard for social anxiety. Since it's so avoided I had to suggest it to the doc as it's never been given to me as an option in the 10+ years I've dealt with this disorder (I'm 28 now). The doctor agreed it's worth a shot so I'm giving it a go. I know that the whey protein powder has a listed value of 200+ mg's for tyramine which common sense would tell you to stay clear. However, that's an amino acid by amino acid breakdown in mg's listed by the manufacturer. Obviously when you buy chicken breasts at the store they just give you the total grams of protein and not the individual amino acid breakdown. I'm sure that chicken breasts (single serving) contain more than 6mg's of tyramine. This is what is so confusing about the whole situation. What separates the two? Instead of cooking 10 chicken breasts a day to meet protein requirements I could supplement with the powder which is what the powder is intended to be. It's pretty much the same as getting my protein through whole food except it's a lot more practical, convienent, and feasable. I just wonder if the issue is in how the protein is manufactured to create the protein powder vs. the protein itself. Again, thanks for the replies. It's much appreciated. H. Upmann
Posted by Phillipa on August 1, 2006, at 23:30:05
In reply to Re: MAOI and protein powder » Phillipa, posted by jedi on August 1, 2006, at 23:04:46
Jedi does the patch cause wt gain too? Love PJ Ed_uk's name for me I'm going to use it now
Posted by jedi on August 1, 2006, at 23:30:29
In reply to Re: MAOI and protein powder, posted by H. Upmann on August 1, 2006, at 23:05:34
> I'm starting the Nardil for extreme social anxiety with a bit of depression as a result of the anxiety. I've tried every concievable med for anxiety - all SSRI's, SNRI's, Remeron, Wellbutrin, Serzone, tri-cyclics, benzos, anti-convulsants, you name it.
...Hi again,
I also suffered from severe social anxiety to go along with my major atypical depression. I believe your research is correct; Nardil is simply the best medication for this disorder. Be careful though, when I first took Nardil, ten years ago, it caused some hypomania that I just interpreted as feeling better. Not everyone will get this side effect, but it can happen. I ended up making some not too sound financial decisions, that set me back for several years.I augment Nardil with 1mg of clonazepam daily. This is also a very good med for the social anxiety. I believe, like Nardil, the effect on GABA is the reason. In higher doses of 3 or 4mg, clonazepam can be very effective on social anxiety, stand alone.
Wishing you the best.
JediPS Please do not take anything that has 200mg of tyramine. We are talking the long dirt nap here!
Source:
http://www.dr-bob.org/tips/maoi.html#Saklad
Posted by Declan on August 1, 2006, at 23:48:52
In reply to Re: MAOI and protein powder, posted by H. Upmann on August 1, 2006, at 22:53:05
The amino acids that I womdered might be problematic were trytophan, phenylalanine, and tyrosine.
Since phenylalanine and tyrosine are the most prevalent in protein powders, the most likely result might be insomnia? (dose dependant, of course)
Posted by jedi on August 1, 2006, at 23:57:04
In reply to Re: MAOI and protein powder » jedi, posted by Phillipa on August 1, 2006, at 23:30:05
> Jedi does the patch cause wt gain too? Love PJ Ed_uk's name for me I'm going to use it now
Hi PJ, (Nice new name)
The research I've read shows no more weight gain than on placebo. More of a chance to have a small weight loss.In placebo-controlled studies (6-8 weeks), the incidence of patients who experienced 5% weight gain or weight loss is shown.
Incidence of Weight Gain and Weight Loss in Placebo-Controlled Trials With EMSAM.
Weight Change EMSAM Placebo
......................(N=757) (N=614)
Gained >=5%...2.1%....2.4%
Lost >=5%.......5.0%....2.8%
Source:
http://www.rxlist.com/cgi/generic4/emsam_ad.htmIn these trials, the mean change in body weight among EMSAM-treated patients was -1.2 lbs compared to +0.3 lbs in placebo-treated patients.
Good luck on your new trial,
Jedi
Posted by Phillipa on August 1, 2006, at 23:59:27
In reply to Re: EMSAM Weight Gain » Phillipa, posted by jedi on August 1, 2006, at 23:57:04
Thanks Jedi I thought so. Love PJ I think I can sign off anyway I want but to be sure Phillipa
Posted by mworkman on August 2, 2006, at 0:10:54
In reply to MAOI and protein powder, posted by H. Upmann on August 1, 2006, at 20:53:57
I think protien breakdown creates more tyramine. I think a product that is as processed as protein powder would create a lot of protein breakdown and more tyramine. That might be the difference between fresh chicken and protein powder.
Posted by Jakeman on August 2, 2006, at 1:37:19
In reply to Re: MAOI and protein powder, posted by mworkman on August 2, 2006, at 0:10:54
There's no definitive evidence that Emasan, even at high doses, requires dietary restrictions.
warm regards, Jake
Posted by SLS on August 2, 2006, at 6:20:40
In reply to MAOI and protein powder, posted by H. Upmann on August 1, 2006, at 20:53:57
I have no comments regarding the need to exclude protein supplements from your diet to maintain safety while taking an MAOI. However, I would like to say that I don't think taking such a supplement is necessary to get real big and real lean. Just reduce your fat and glycemic load and bring up the protein in your diet a bit. Anything more than that is a waste of money and places stress on the liver and kidneys. Of coures, GNC and Joe Weider smile every time the cash register rings up a sale.
- Scott
Posted by djmmm on August 2, 2006, at 10:03:04
In reply to MAOI and protein powder, posted by H. Upmann on August 1, 2006, at 20:53:57
> Hello,
>
> I'm new to this board, but am glad to have stumbled upon it. I have a question that no one can seem to answer. I am going to start taking Nardil (MAOI), and I also like to lift weights which requires increased protein supplementation. Is it safe to use a protein powder (i.e. whey protein concentrate/isolate) with Nardil? Whey protein is a complete protein much like whole eggs are. It will have the same amino acid profile to include tyramine, phenylalanine, and l-tryptophan. My doctor says I can eat all the eggs and chicken I want, but no protein powders. My question is what is the difference? They both have similar amino acid profiles, and assuming these are fresh and obviously not aged proteins why would it be a problem? I know tryptophan is contraindicated with MAOI's, but turkey is certainly not excluded from the dietary restrictions although it contains high levels of tryptophan. Can anyone tell me why a protein powder by itself with no additional ingredients (herbs or stimulants) would be a problem? I've called several Walgreens and they just regurgitate what the computer spits out for Nardil and contraindications. I need someone with some knowledge on this to speak up if they have time.
>
> I also smoke the occasional cigar that is aged tobacco. Obviously I don't eat the cigar or inhale, but is it still a risk to smoke the occasional cigar? Would there be any appreciable amount of tyramine in the smoke itself? If you have an answer for either of these questions I'd be most grateful. Nobody seems to know. The pdoc told me I probably know more about this archaic med than he does, (how reasurring is that?!?), and he couldn't say for sure on the protein powder except of course the disclaimer to avoid it anyways. If you know the answer I will fricken pay you for it. Please help me out with this if you have the knowledge and opportunity. Thanks for your time.
>
> H. UpmannI've used Nardil with MLO protein (weight gainer, etc) and GNC "100% whey protein" and had absolutely NO problems... (I've also used amino acid supplements with Parnate)
Posted by Declan on August 2, 2006, at 14:05:43
In reply to Re: MAOI and protein powder, posted by djmmm on August 2, 2006, at 10:03:04
Which ones?
Posted by Jost on August 2, 2006, at 17:44:32
In reply to Re: MAOI and protein powder, posted by H. Upmann on August 1, 2006, at 23:05:34
Different foods have different amounts of tyramine. Other foods, besides meats, have tyramine, since incomplete amino acids make up many foods. Plus handling,and preparation may cause the amount of tyramine to be greater. For example. eggs are okay, but egg salad left out, rather than refrigerated, could spoil and even though edible, have much more tyramine than is safe.
I don't know how much tyramine would be in any one dose of the protein powder that's in the supplement, or how often you take it.
However the following is a paragraph from one of Dr. Bob's pages on tyramine interactions:
"The tyramine content of foods varies greatly due to the differences in processing, fermentation, ripening, degradation, or incidental contamination. Many foods contain small amounts of tyramine and the formation of large quantities of tyramine has been reported if products were aged, fermented, or left to spoil. Because the sequela from tyramine and MAOIs is dose-related, reactions can be minimized without total abstinence from tyramine-containing foods. Approximately 10 to 25 mg of tyramine is required for a severe reaction compared to 6 to 10 mg for a mild reaction. Foods that normally contain low amounts of tyramine may become a risk if unusually large quantities are consumed or if spoilage has occurred (McCabe, 1986)."
Given that tyramine content even in the same foods varies from sample to sample, and that protein powders are not regulated, using it could lead to very unfortunate consequences.
Jost
Posted by H. Upmann on August 2, 2006, at 21:00:38
In reply to Re: MAOI and protein powder » H. Upmann, posted by Jost on August 2, 2006, at 17:44:32
Good call Jost. I suppose it's too great of a risk to take. I'll eat a bunch of eggs and chicken breasts I guess. Then again, I'm not sure when the unusually large quantity effect takes effect. I need 250 grams of protein per day to continue to build lean muscle mass. It's just a fact that protein is essential to building muscle, and if you are continuously breaking down the muscle you need to help repair it with protein.
I appreciate all the posts. I should mention that protein powder has NEVER been shown to be harmful on the kidneys EXCEPT in patients with pre-existing renal problems already. It's then much more of a burden on the kidneys. This is definitely one myth that needs to be put to rest though.
I don't suppose anyone could answer the cigar question? It's not like smoking a cigarrette. I don't inhale them, but they are aged tobacco (some 18 years or more), and the tobacco has been "triple fermented" in many cases (Cohiba cigars undergo extensive fermentation). I think I'm answering my own question here. This probably isn't a good idea either. Although, I have never seen one contraindication for cigar smoking or smoking in general. This does indeed sound like a scary med. I'm sure it's overblown, but I know that precautions must be taken. This is pretty much the last med I can think of for social anxiety so I'll give it a go and see what happens. If anyone has had social anxiety (severe) and has had success with meds could you post what seemed to work for you?
Again, you guys are great! I really am grateful for the responses. Thanks again. -H. Upmann
Posted by H. Upmann on August 2, 2006, at 21:03:30
In reply to Re: MAOI and protein powder, posted by djmmm on August 2, 2006, at 10:03:04
Thanks for the input djmmm. I appreciate it. I really believe that it is possible to safely take a protein powder, but it does seem like a ridiculous risk to take considering the results could be unforgiving. Also, as dietary supplements are basically unregulated I guess it's playing with fire. Thanks again. H. Upmann
Posted by Jost on August 2, 2006, at 21:30:10
In reply to Re: MAOI and protein powder, posted by H. Upmann on August 2, 2006, at 21:00:38
I've never heard about smoking as a transmission route for tyramine.
Even if tobacco is aged, smoking presumably destroys the leaf, and the residues are ?what???-- I don't know, but I've never heard anyone mention smoking of any type as a problem. There would be a huge issue, if it were.
So, at least you can smoke-- although, actually, smoking cigars isn't so good for you, on other grounds.
Good luck with Nardil. Sure hope it helps.
Jost
Posted by H. Upmann on August 2, 2006, at 21:42:48
In reply to Re: MAOI and protein powder » H. Upmann, posted by Jost on August 2, 2006, at 21:30:10
Thanks again Jost. The pharmacist I talked to at WalGreens said that by smoking the tobacco it would release amines and go directly into the blood stream and very definitely be able to cause a reaction. I have no idea though. Half the pharmacists say yes and the other half say probably not. Cigars are a bit different than regular cigarettes. I was wondering if there could be any appreciable amount of tyramine in the smoke itself or how long it would take to build up to 6mg's of tyramine.
For sure it's not the healthiest thing to do, but you see far more old cigar smokers than cigarette smokers. Smoking a good cigar on a special occasion is really all I'm talking about. Certainly not an everyday event. Thanks again for the response. All the best! -H. Upmann
Posted by Jost on August 3, 2006, at 0:30:00
In reply to Re: MAOI and protein powder, posted by H. Upmann on August 2, 2006, at 21:42:48
It;s an intereting question, which I'll ask my pdoc, who prides himself on knowing about these things. I may see him soon.
Did the pharmacist give any sources, cause you should check further ? My pdoc has worked with Nardil and Parnate for a longtime, and would be as likely a person to answer the question as anyone I know.
So, if it becomes evident, I"ll let you know
Jost
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.