The Tyramine Principle

It would be hard to avoid something like tyramine in your diet without understanding what it is. Otherwise it's hard to predict where it might show up, and you're left bound to whatever was on the last "allowed foods" list you read.

This page on a low-tyramine diet is very helpful in that regard. I like patterns better than rote memorisation.

Tyramine is a natural substance formed from the breakdown of protein as food ages.

Der! My migraine specialist had said that avoiding tyramine would involve a more European-style diet, shopping and cooking right away. Until reading that page I thought he was referring to avoiding prepared foods with preservatives. Sure, those too, but tyramine levels can increase in my own home--just having them around for a while can have that effect.

Fermentation. Fermentation is the devil. I'm not avoiding soy sauce because of the soy, but because of the fermentation. So soy milk may be back on the list. Good to know, especially since I intend to limit dairy.

Any protein food, improperly stored or handled, can form pressor amines through protein breakdown. Chicken and beef liver, liver pate, and game generally contain high amine levels due to frequent mishandling. Game is often allowed to partially decompose as part of its preparation.

There's so much reading to be done. I'll never finish.

Diet Plan

Had another appointment with the specialist today. He's been stonewalled in his attempt to get me anaesthetised either as an in- or an out-patient, so he's going try and get me a referral to Cedars Sinai.

He's out of medicine, he says.

I brought up dietary mods, and he agrees that tyramine and wheat are a good place to start, although wheat is difficult. I don't doubt that for a second. The idea is to quit as much as possible for three or four weeks, and if it has made a difference, start introducing foods slowly back in and see what makes the needle wiggle.

I figure wheat will be the first thing back in, if I don't snap horribly beforehand. His tyramine recommendations are from the National Headache Foundation, and look...oh, I don't know what's doable and what's not. His summary of the whole thing is that I'll be eating European-style--fresh food, freshly cooked. It would be great if it were just that simple.

Here's what I can have:

* fresh meat, poultry, eggs.
* a fairly generous range of foods dairy-wise, but I don't think I'll take advantage of that. Since I can get protein from meat, I won't lean on cheese for it instead.
* most vegetables and fruit

It also seems to be limiting my chocolate and molasses and licorice consumption. Honestly, putting chocolate in that sentence makes it seem so much less appealing I could even give that up for a heartbeat or two.

I figure that in the first day or so of the juice cleanse I'll do a long slow Wholefoods/Trader Joe's shopping excursion and lay out a plan for a few weeks of healthy eats, and work out how often I'll need to be shopping to sustain this lifestyle.

Potential toxin #1: Tyramine

http://en.wikipedia.org/wiki/Tyramine

My specialist mentioned that one of the few medications left untried was something tied into adrenaline, but that would require dietary modification because I would run the risk of ending up with either too much adrenaline in my system, or too much adrenaline precursor. From reading the Wikipedia entry on tyramine I wonder if it's related. I'm pretty sure he also mentioned MAOI inhibitors.

In humans, if monoamine metabolism is compromised by the use of monoamine oxidase inhibitors (MAOIs) and foods high in tyramine are ingested, a hypertensive crisis can result as tyramine can cause the release of stored monoamines, such as dopamine, norepinephrine, epinephrine.

The entry goes on to say there are no conclusive links between tyramine and migraines, but, well, conclusive isn't helping much is it? So this is a possible avenue of deprivation to explore:

Foods containing considerable amounts of tyramine include meats that are potentially spoiled or pickled, aged, smoked, fermented, or marinated (some fish, poultry, and beef), most pork (except cured ham), chocolate, alcoholic beverages, and fermented foods such as most cheeses (except ricotta, cottage cheese, cream cheese), sour cream, yogurt, shrimp paste, soy sauce, soy bean condiments, teriyaki sauce, tofu, tempeh, miso soup, sauerkraut, broad (fava) beans, green bean pods, Italian flat (Romano) beans, Chinese (Snow) pea pods, avocados, bananas, eggplants, figs, red plums, raspberries, peanuts, Brazil nuts, coconuts, processed meat, yeast, and an array of Cacti.

I just have to find out what would be left over, especially when it comes to proteins--poultry, beef, some fish, and most pork? What's left? As is, it doesn't look sustainable for too long. If the reduced diet is stressful, after all, the whole effort will be counterproductive.

There are foods that are already and clearly on my no fly list, since my sensitivity is dramatic and swift.

Aspartame: I want to say all artificial sweeteners, but that doesn't make sense--it's probably just that I dislike Splenda. I avoid them mostly anyway because of the slippery mouth feel and unpleasant aftertaste, but now I even avoid most chewing gum, since ten minutes of chewing can start the pain.

Nitrites: This is another one I discovered by myself. Suddenly pepperoni pizzas were no longer palatable. I studiously avoid all sausage with nitrites in them, and limit my bacon intake--it's good that I live in a large enough market that I can find breakfast meats light on the preservatives.

Mint: Not always, but sometimes. And when it does, it sends me over hard. Often it's mint and sweet, which is why I don't chew gum anymore, and why I've switched to weirdo toothpaste.

These are the biggies--the ones where I still have the taste in my mouth when the pain sets in. They are the easy ones, since I don't miss them. Feeling them trigger pain makes them no longer tasty. I have some misty technical sadness at the loss of pepperoni, but I can't look at a slice of the pizza with hunger anymore.

The next part of the investigation will be much more complicated.

Next week. Next week it is. The cleanse starts next Friday, for three days.

Which gives me a week to decide how limited the ensuing diet will be. No wheat? Gluten? Yeast? Caffeine?

Tick, tick, tick.

"He can thoroughly enjoy the pepper when he pleases"

http://www.prweb.com/releases/2008/03/prweb735184.htm

I'll have to go track that down. I don't relish the idea of spraying hot pepper up my nose, but these are desperate straits, and the FDA says it's okay.

Hell, I poured vinegar up my nose (don't ask) on much less authority, so this'll be nothing.