![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
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
Posted by H. Upmann on August 3, 2006, at 21:23:36
In reply to Re: MAOI and protein powder » H. Upmann, posted by Jost on August 3, 2006, at 0:30:00
New pharmacist says protein powder is no problem. I still will stay clear, but man does anybody still study MAOI's anymore? Have these been almost entirely abandoned? I wouldn't be surprised if they eventually discontinue the whole line. I guess with the heavy marketing and safety profile of SSRI's there's no incentive for docs to keep up on these meds. That's unfortunate because they appear to be underprescribed, misunderstood, and help quite a few people. Thanks again for the reply Jost. If you do hear anything from your doc please keep me posted. Best regards. H. Upmann
Posted by willyee on August 5, 2006, at 9:18:07
In reply to Re: MAOI and protein powder, posted by H. Upmann on August 3, 2006, at 21:23:36
SLS i feel is right,you ever look at the stores,they make those bottles so pretty and tempting dont they.
I have lifted sinde i was 16,in my mid 20`s i was a supplement nut,i had tubs of this and that,and never noticed any real gains except for bills weighing down my draw.
No one wants to hear it,but the best way is to really find some unqique workout strategies.I recomend if u can lifting at home,you dont have the distractions,the time limit of someone staring at you waiting for a machine,your not tempted to try other things.
A good old fashion weight set is the best,look and see how you can be creative in your lifting,muscles respond highly to being tricked.
I work out far less now,how differently,examply for myself i came up with a idea of one arm a single day,not alternate,why switch.I just literaly blast the single arm im working on over and over,i dont keep track,when i feel im done im done,i just keep building pressure on that single arm all day.
Aside from benching i might just jump down periodicaly and do push ups,setting the same time everyday and same reps,sets,etc was when i had no gains,they say the best gains are to trick your muscles,i dont supplement at all and i went from 180 to 250,i have some fat in the area most people do as situps dont help,however my energy went up to,when my weight when up,my lifts did too,and i noticed where as before with tons of supplements id feel drained and discrougaed,now my bench is approx 325 pds,i curl with 60 d dumbells but have picked up 80 pds in a gym,and i just have an easier time with gains.
Not to stay off topic,if you go the supplement route,l glutamine,is a good amino acid thats always spoken of in groups,i also believe one of us here was semi professional,since he did not mention it,i wont,but way to go man.L Argnine,L-oorthnine, have also been used.
Posted by willyee on August 5, 2006, at 9:28:46
In reply to Amino acids and Parnate » djmmm, posted by Declan on August 2, 2006, at 14:05:43
> Which ones?
If you mean which amino acids might aid a maoi in its mental benifits,id imagine dlpa,l tyrosine,l taurine,l glycine,just to think of a few.
Im not recomending these,using aminos on maois can be as if not more serious than everything else mentioned.
If youre refering to which ones for lifting,common ones used are l-gluamtine,l-Arginine,l-orhinine,l-cartnine,...others im sure as well these are most common.
Id visit one of the many many sites and groups who discus this because there are safe ways to do so,usualy these are cycled,off and on,the ones i mention above when supplemented alone either allegedly aid in muscle or fat loss,but the information about them in ties with weight training are abundant.
As far as adding a amino to maoi,for aid in the maoi,personaly id go as far as taurine,amino acis are natural yess,but not in gram doses they are sold as.
Also not in conjunction with medication that are adjusting levels of the brain checmicals that these aminos can affect,many of them do cross over into the brain,and u dont wanna hurt yourself toting with something like l tyrosine unless you really know what your doing.
Ah i believe i forgot l-tryptophan,how in the world could i,that is also another brain altering alleged one that is used.If u ave a interest,id recomend getting a cheap book that runs down each amino,there really interesting to learn about.
Posted by jedi on August 6, 2006, at 2:03:39
In reply to Re: MAOI and protein powder, posted by H. Upmann on August 3, 2006, at 21:23:36
> New pharmacist says protein powder is no problem. I still will stay clear, but man does anybody still study MAOI's anymore? Have these been almost entirely abandoned? I wouldn't be surprised if they eventually discontinue the whole line. I guess with the heavy marketing and safety profile of SSRI's there's no incentive for docs to keep up on these meds. That's unfortunate because they appear to be underprescribed, misunderstood, and help quite a few people. Thanks again for the reply Jost. If you do hear anything from your doc please keep me posted. Best regards. H. Upmann
Hi,
As a long time user of MAOIs, I believe that you have to go to the next level in responsibility when taking these medications. I do all of my own research before taking anything with Nardil. I once had a pharmacist from a major chain give me completely bogus information about a cough syrup with Nardil. A trip to the ER and $1000 CT scan convinced me not to trust anyone but myself. MDs have given me totally inaccurate information about the meds. I will use the information on babble to see what others have used safely and then verify that through PUBMED and other sources. Its your life and when taking MAOIs you want to be very careful with it.
Take care,
Jedi
PS A pharmacist that tells you it is ok to take 200mg of tyramine in one dose while on Nardil, needs to go back to school.
Posted by laima on August 12, 2006, at 7:51:50
In reply to Re: MAOI and responsibility » H. Upmann, posted by jedi on August 6, 2006, at 2:03:39
Good warning- thank you! I'm shocked about the pharmacist.
> > New pharmacist says protein powder is no problem. I still will stay clear, but man does anybody still study MAOI's anymore? Have these been almost entirely abandoned? I wouldn't be surprised if they eventually discontinue the whole line. I guess with the heavy marketing and safety profile of SSRI's there's no incentive for docs to keep up on these meds. That's unfortunate because they appear to be underprescribed, misunderstood, and help quite a few people. Thanks again for the reply Jost. If you do hear anything from your doc please keep me posted. Best regards. H. Upmann
>
> Hi,
> As a long time user of MAOIs, I believe that you have to go to the next level in responsibility when taking these medications. I do all of my own research before taking anything with Nardil. I once had a pharmacist from a major chain give me completely bogus information about a cough syrup with Nardil. A trip to the ER and $1000 CT scan convinced me not to trust anyone but myself. MDs have given me totally inaccurate information about the meds. I will use the information on babble to see what others have used safely and then verify that through PUBMED and other sources. Its your life and when taking MAOIs you want to be very careful with it.
> Take care,
> Jedi
> PS A pharmacist that tells you it is ok to take 200mg of tyramine in one dose while on Nardil, needs to go back to school.
Posted by kimcrazylady on August 17, 2006, at 11:28:32
In reply to Re: MAOI and responsibility » H. Upmann, posted by jedi on August 6, 2006, at 2:03:39
I have been on Parnate forever, and I use protein powders without problems. I make a thick shake in the morning as my breakfast.
I use Spiru-tein and have for years without problems.
Hope that helps.
Kim
Posted by jedi on August 17, 2006, at 12:15:32
In reply to Re: MAOI and responsibility, posted by kimcrazylady on August 17, 2006, at 11:28:32
> I have been on Parnate forever, and I use protein powders without problems. I make a thick shake in the morning as my breakfast.
>
> I use Spiru-tein and have for years without problems.
>
> Hope that helps.
>
> KimHi Kim,
I really know nothing about protein powders so I plead ignorant on that one. However, H. Upmann said "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." The research studies use 6mg of tyramine to denote a dangerous level. I have read that 10mg can cause a minor hypertensive event and 25mg can cause a major crisis. From this information, I conclude that any substance with 200mg of tyramine per serving will cause a major hypertensive crisis for most people taking an irreversible MAOI.
Take care,
JediJ Clin Psychopharmacol. 1996 Oct;16(5):383-8.
Tyramine content of previously restricted foods in monoamine oxidase inhibitor diets.
Walker SE, Shulman KI, Tailor SA, Gardner D.
Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.Traditional monoamine oxidase inhibitors (MAOIs) remain an important class of drugs for a variety of psychiatric conditions, including depressive illnesses, anxiety, and eating disorders. It was the objective of this study to refine the MAOI diet by determining the tyramine content of a variety of untested and "controversial" foods that continue to appear on MAOI diet-restricted food lists. A secondary objective of the study was to evaluate the effect of freshness on the tyramine content of some foods. Fifty-one food samples were evaluated for tyramine content by liquid chromatography. Food samples included a selection of sausages, beverages, sliced meat products, including chicken liver, and some fruits, including raspberries, bananas, and banana peels. Foods that were found to have dangerously high concentrations of tyramine (> or = 6 mg/serving) included chicken liver aged 9 days (63.84 mg/30 g), air-dried sausage (7.56 g/30 g), soy sauce (0.941 mg/ml), and sauerkraut (7.75 mg/250 g). Of the foods analyzed in this study, only those with high tyramine content per serving should continue to be absolutely restricted. All other foods are either safe for consumption or safe in moderation. The data provided should be combined with the data from other similar analytical studies to develop a list of foods that should be absolutely restricted. A more accurate list of restricted foods may enhance patient dietary compliance.
PMID: 8889911 [PubMed - indexed for MEDLINE]
Posted by H. Upmann on August 18, 2006, at 8:12:07
In reply to Re: MAOI and responsibility » kimcrazylady, posted by jedi on August 17, 2006, at 12:15:32
Jedi,
I made a mistake about the protein powder. Sorry for the confusion. It was 700+ mg's of Tyrosine I believe. There is no listed content for tyramine. Below is the amino acids per scoop as a typical profile. I'm sure breaking an egg down into an amino acid profile would show a similar breakdown since it also has a high biological value for protein.
Kim, what kind of shake do you use in the morning? Since I lift weights I want to use a supplement such as a Met-Rx pack, Myoplex, etc. I only avoid soy protein (and I'm not sure if that's a big deal). I have read that soy isoflavones have triggered hypertensive crisis before (I'll try to find the study) Oddly, the patient wasn't even on an MAOI. The following is the breakdown for my Whey protein supplement shake:
100% Whey Gold Standard
Optimum NutritionPlease note: Nutritional content may vary between 100% Whey Gold Standard flavors.
Serving Size: 1 scoop (30.4g)
% Daily Value*
Calories - 120
Calories from Fat - 10
Total Fat - 1g 2%*
Saturated Fat - 0.5g 5%*
Cholesterol - 30mg 10%*
Total Carbohydrate - 3g 1%*
Sugars - 1g ?#60;/font>
Protein - 24g 48%*
Potassium - 220mg 6%*
Calcium - 140mg 14%*
Sodium - 60mg 3%*
Typical Amino Acid Profile
(milligrams per scoop)
Essential Amino Acids
(EAAs)
Tryptophan 405
Valine 1422
Threonine 1654
Isoleucine 1573
Leucine 2531
Lysine 2233
Phenylalanine 748
Methionine 492
Conditionally Essential Amino Acids
(CAAs)
Arginine 505
Cystine 494
Tyrosine 703
Histidine 423
Proline 1509
Glutamine & Precursors 4082
Nonessential Amino Acids
(NAAs)
Aspartic Acid 2508
Serine 1126
Glycine 412
Alanine 1180
Ingredients: Protein blend (whey protein isolate, whey protein concentrate, whey peptides), cocoa, natural and artificial flavor, lecithin, salt, sucralose, acesulfame potassium. * percent Daily Values are based on a 2,000 calorie diet.
?Daily Value not established.
Suggested use:
Posted by elanor roosevelt on August 20, 2006, at 6:58:57
In reply to Re: MAOI and responsibility, posted by kimcrazylady on August 17, 2006, at 11:28:32
Whey is a by profuct of an aging process -- milk to cheese.
Posted by H.Upmann on August 20, 2006, at 12:26:44
In reply to Re: MAOI and responsibility, posted by elanor roosevelt on August 20, 2006, at 6:58:57
So you're saying it should be a direct contraindication? I'm wondering if these protein supplements are created by a different process. It's never on a list for contraindications so it's a bit confusing. Some pharmacists say it's OK, some don't. I mean drinking an Ensure or Slim Fast will have a degree of whey protein in it. You would think the more popular protein supplements that have enough exposure would have MAOI's listed as something not to mix with. I don't get it.
Posted by MavsFan on October 13, 2006, at 11:13:10
In reply to Re: MAOI and responsibility, posted by H. Upmann on August 18, 2006, at 8:12:07
> Jedi,
>
> I made a mistake about the protein powder. Sorry for the confusion. It was 700+ mg's of Tyrosine I believe. There is no listed content for tyramine.>I am struggling with this very issue now. I want to go on a detox program that utilizes protien powders in the nutritional portion of the program. Thus, I am doing all of the research I can to decide whether to attempt utilizing any form of protein powder. The only mention I have seen in any of the literature regarding MAOI's and protein powder is a reference to whey protein powders in a single study, without any explanation as to why it is prohibited.
Tyrosine is the amino acid in protein, that through decarboxylation (which generally occurs due to aging or spoiling) becomes tyramine. Tyrosine, however, is NOT tyramine and, as long as it is not spoiled should present no problem.
I think what I have personally decided to do is to try Rice Protein Powder, which contains no whey and no soy. As with anything that presents a risk, I will try it in very small amounts first to see if there is any reaction at all. I'll report back on what I discover.
This is the end of the 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.