The following guidelines are provided where amines, particularly tyramine, are suspect in headaches, migraines or other food sensitivity symptoms. Amines should not be the only exclusions since where they cause reactions other food chemicals are also likely to also be a problem. These include additive colours, flavours, preservatives, monosodium glutamate, and natural salicylates. So diet investigation should begin with a low chemical elimination diet such as that outlined in Are You Food Sensitive? This idea also works the other way in that all food sensitive people investigating their diet need to exclude amines as those who react to additives, spices and MSG are also likely to react to amines. [Where amine restriction accompanies the use of MAOI medication only tyramine needs to be excluded.]
So amines should be minimised, as part of the exclusions in an initial elimination diet for investigation into food intolerance.
The variation in amine content in food from the research is reflected in the variation in tolerance in practice.Some elimination diets begin by excluding all foods known to contain any amines at all. This is rarely necessary, as those who always react to the following foods are quite clear about the need for their exclusion. It is important that the suggestions provided for tolerance are followed as the amine content of foods is not an all-or-nothing position. Amines can increase dangerously as the food changes with age or ripening.
The following foods may be used in the initial diet trial using the diet detective method, with the stated qualifications:Bananas, avocado, and broccoli, figs, sugar bananas and cauliflower may be used as long as they are “just ripe”.
Mild flavoured spinach may be used.
Pork may be used, as long as, it is bought on the day the butcher gets it in and cooked that day or frozen.
Canned tuna or salmon can be used, as long as they are bought from a shop with a high turnover, and used that week. Once opened the food has to be eaten that day or frozen.
Ham and bacon may be used if bought fresh from a big self serve deli section where it has not been aged at all. The food has to be eaten that day or frozen. The amount must be limited so it is wise to use them just as a flavour in the initial diet trial.
Malt or white spirit vinegar may be used sparingly in a freshly prepared food.
Very fresh nuts [except almonds – excluded because of salicylates].
Copha is allowed.
Meat browned only until it smells good to the individual.
Add exclusion of any food that “smells stale” to the susceptible person
Add exclusion of any food that “tastes strong” to the susceptible personThe quality of the flavour matters greatly, and is a good guide to tolerance.
Food sensitive individuals have a very good sense of smell. Use it!!
Once diet is established, after 4 weeks, individual food trials can be taken
Note:- individuals vary in what they think they can tolerate. That is true as what is tolerated by one may not be tolerated by another. One person may tolerate ripe bananas, chocolate, and an occasional wine, but not aged rump or home-made gravy in the pan. Another may never tolerate chocolate, wines, but tolerate just ripe banana, mild avocado, canned fish, and limited fresh ham. So it is important to test each amine-containing food separately and not assume that where one is not tolerated another will also cause reactions.
Reactions also depend on “the total body load” of other suspect substances, such as salicylates, additives, MSG, stress, smells, hormone changes, and other factors listed as part of the total body load. Work with an experienced dietitian and read “Are you food sensitive?”
Each of the following can be trialled, one at a time, each in gradually increasing doses until symptoms appear, or for seven days.
Matured cheese, in small amounts, only if it smells very fresh.
Wine, as long as it has a “good quality bouquet” to the individual.
Chocolate is either tolerated or not tolerated. Unlike other amines the tolerance of chocolate is less likely to be related to quality of flavour, but it is sometimes.
What do people tolerate in the real world?There are two parts to thinking about amine sensitivity. One is what the research says from analysis of the amine content in foods. This is very useful and the content listed below is helpful. However since the amine content can vary greatly with the amount of aging, or stage of ripening of the food, the figures reported below may not relate to the very fresh food you may want to trial. Note that the figures do often give a range of content that is very wide. Where people are very motivated all food which contain any amines may be excluded initially.
The other aspect of amine sensitivity is what patients report tolerating or not. Individuals do vary in which amines they tolerate and the dose they tolerate. I have met many people who can eat an amine-containing food as long as they have bought it themselves making sure it is very fresh and it smells high quality to them. But they may not tolerate it if eaten two or three days in a row.
Irritable bowel syndrome [IBS] reactions reported are often after eating out probably because the food is more likely to be aged or “rich”, which is usually high in amines and other suspect chemicals. They report reactions after aged meats, including lambs fry [with a strong smell], and after cheeses that smell “stale” or “off” to the individual. It is of interest to note that chocolate is very often reported to cause migraines, but rarely produces the bad gut urgency and cramping of IBS.
What does the research say? Advice provided on lowering amines in diets is based on analysis data, and also on reports of foods reported to induce severe reactions in patients on Monoamine oxidase inhibitor [MAOI] medication.
Normally amines are oxidised by MAO enzymes in gut, nervous system and in platelets.
On MAOI medication amines are not oxidised and patients notice headaches and some have rises in blood pressure – hypertensive crisis – which can be fatal. They need dietary advice to exclude foods containing amines.
From the research analysis we can learn that amines are formed in food by a number of different processes, and that there is the wide variation in the amount of biogenic amines in suspect foods. So people can react to a food on one occasion and not on another.
Variations in amine concentration is caused by:
1. the source of the foodstuff – proteins can provide the nitrogen in amine production
2. storage conditions – amines increase in the aging of meats and maturing of cheeses
3. fermentation – in brown [fermented] sauces and in Vegemite, Promite and Marmite
4. method of preparation – amines increase at particular temperatures and in browning
5. time, amines increase with storage before and after cooking, and during aging
6. temperature – amines are produced at ideal temperatures for enzyme function
7. acidity – lower acidity increases the amount of amines produced
8. cooking – increases volatilisation and decreases content
An increase in flavour intensity – sharpness – is associated with increased levels of amines.
Different amines are increased during deterioration (putrefaction) of food.
The research literature does acknowledgement individual variation in tolerance. This is known from clinical reports of reactions in people on MAOI medication. Different people may react to particular amines, or at particular doses. Diet detective work can help you work out just what you need to be careful about. See Are You Food Sensitive?