Auto-SummaryThis forum discussion explores the dietary restrictions when using Syrian rue (a MAOI) in combination with other psychedelics, focusing on the reversible nature of harmalas in Syrian rue versus irreversible synthetic MAOIs. Key points include:
1. Syrian rue's harmalas are reversible, meaning they can be displaced from the MAO enzyme, lowering the risk of hypertensive crises compared to irreversible synthetic MAOIs like moclobemide.
2. Displacement of tyramine by Syrian rue's harmalas is generally safe and unlikely to cause hypertensive crises, though rare cases of nausea have been reported.
3. The diet for Syrian rue users is less restrictive than for synthetic MAOIs, with some foods like avocados, bananas, and aged cheeses being unnecessarily restricted.
4. Personal anecdotes show that many long-term MAOI users maintain a lenient diet, emphasizing that dietary restrictions can be more flexible than previously thought.
5. Experts suggest that while tyramine intake should be monitored, modern understanding of MAOIs allows for a more relaxed approach to diet.
The consensus is that with Syrian rue, dietary restrictions are more lenient than with synthetic MAOIs, but caution is advised. Accidental ingestion of spoiled foods containing tyramine could still
mush_monkey said:
So, about the serotonin syndrome and stuff. If you're taking, say, 3 grams of Syrian rue + 3 - g of mushrooms, how important is to follow dietary restrictions and for how long before and after the deed?
We still need to figure out this phenomenon and frankly, we need people to cautiously test the waters. The whole foods-will-put-you-in-the-hospital thing with MAOIs applies to synthetic MAOIs that powerfully affect the enzymes, i.e. covalently bonding to them, which is permanent:
Mechanism of Action of MAOIs
The propensity for food and drug interactions of MAOIs is related to their mechanisms of action. The MAOIs inhibit monoamine oxidase (MAO), an enzyme that catalyzes the oxidative removal of monoamines, including serotonin, histamine, and the catecholamines dopamine, norepinephrine, and epinephrine, as well as trace amines.5 By covalently bonding to MAO enzymes, MAOIs prevent the removal of these amines, resulting in their increased synaptic availability. Some MAOIs bind to the enzyme for its lifetime (a duration of 2 to 4 weeks) and are, thus, classified as irreversible; reversible MAOIs can be displaced from the enzyme.
Dietary Restrictions and Drug Interactions With Monoamine Oxidase Inhibitors: An Update. David A. Flockhart, MD, PhD, The Primary Care Companion for CNS Disorders, Jul 15, 2012
Thankfully, the harmalas in Syrian rue are the reversible type. So what exactly does that mean?
Patients treated with moclobemide are at lower risk for hypertensive responses to TYR; moclobemide is a RIMA which can be displaced from MAO by higher concentrations of TYR and of [norepinephrine] released by TYR. This displacement restores the activity of MAO and allows it to catabolize TYR and released NE. The labeling for moclobemide carries warnings about ingesting high-TYR foods that are similar to those for irreversible MAOIs despite clear evidence in the literature that, with moclobemide doses of up to 900 mg/day, a TYR-restricted diet is not necessary (5,30).
Pharmacist Toolkit: Monoamine Oxidase Inhibitors. Rex Lott, PharmD, BCPP. Lincoln, NE: American Association of Psychiatric Pharmacists, 2022 (Interaction with Tyramine-Containing Food (“Cheese” Effect))
There's also a preview of this PDF in the Internet Archive: https://web.archive.org/web/20240223212036/https://aapp.org/guideline/maoi/interactions
So, is this displacement a smooth efficient process or is there an initial headache that doesn't go away until the displacement completes?
Some people are concerned about it, even knowing of the reversible/displacement action.
Many sources of information referring to general MAOI food interactions are specifically with regard to non-selective irreversible pharmaceutical MAOIs such as Parnate and Nardil, applying somewhat less or not at all to Syrian Rue which is much safer than pharmaceuticals. RIMAs are displaced by tyramine on the MAO enzyme therefore tyramine can be metabolized so a hypertensive crisis is not easily encountered using Syrian Rue like it is using pharmaceutical MAOIs. Using Syrian Rue as an MAOI, tyramine is more likely to produce nausea than a hypertensive crisis.
It is not very difficult to eat a Syrian Rue compliant diet and with all of this information available, bad experiences will be rare but not altogether eliminated. Even with dietary knowledge – accidents happen. On one occasion I ate a large amount of processed de-shelled sunflower seeds that contained tyramine. Although Sunflower seeds contain no tyramine, they can spoil. Although I opened the bag and it was within the freshness date – that bag was spoiled and contained enough tyramine to make me sick.
https://syrianrue.org/dietary-guidelines/
I'm skeptical of this person's claim. I think he may suffer from the condition of being an idiot. Because people who are actually on Nardil and Parnate basically say that they don't have to make any changes in their diet and this is backed up by research. Also, displacement means the harmalas are no longer in their place, doing their job, so it would be interesting to see how quickly tyramine kills your trip. But, again, this calls for cautious experimentation because maybe a sickness is induced, even if it isn't hospital-level.
“It's very rare to have a hypertensive crisis while on MAOIs, but the danger is there and you can get one when you least expect it. Took me two years to find out how it felt like. I ate spoiled meat and it gave me a splitting headache, felt like my head was about to explode. Before that incident i had been eating everything and paid the diet no concern at all.”
“I still don't care about the diet, but gourmet cheese and spoiled food should be avoided at all costs.”
ChopSuey, 9/22/14, Re: MAOI "diet" by psychiatrists - a joke?
“I don't drink beer on tap, eat artesian cheeses, or consume homemade fermented goods. I also don't eat much soy sauce. I didn't consume these foods pre MAOI anyway. Most of the information regarding food restrictions is dated and inaccurate. I've used MAOI's for about two years. After the first 2 weeks or so I don't really even think about diet restrictions.”
TechnicalCatch, May 13, 2024, reddit
“if the conclusion is anything other than tyramine and all mess that goes along with it is anything other than Hocus Pocus old science then it's meaningless collectively. I have been [tranylcypromine] for like 30 years and long ago I forgot entirely about all that tyramine and preserved sausages and stuff like that, and yet here I am, happy and healthy”
pumbungler, Jun 3, 2024, reddit
Research:
The dietary restrictions classically advised for patients taking oral MAO inhibitors were established to prevent hypertensive crises associated with tyramine ingestion. However, some of these restrictions were unsubstantiated,[38] and evidence from more recent studies suggests that they are unnecessarily strict[39]
[...]
Among the many foods determined to be unnecessarily restricted are avocados; bananas; beef or chicken bouillon; chocolate; fresh and mild cheeses, eg, ricotta, cottage cheese, cream cheese, processed cheese slices; fresh meat, poultry, or fish; meat gravy (fresh); monosodium glutamate; peanuts; properly stored pickled or smoked fish (eg, herring); raspberries; and yeast extracts (except Marmite).[39]
[...]
Absolute dietary restrictions include[39]:
- Aged cheeses and meats
- Banana peels
- Broad bean (fava) pods
- Spoiled meats
- Marmite
- Sauerkraut
- Soybean products
- Draft beers.
MAO Inhibitors: Risks, benefits, and lore. Wimbiscus, Molly MD; Olga Kostenk, MD; Donald Malone, MD. Dec 2010. Cleveland Clinic Journal of Medicine. 77 (12) 859-882. DOI: 10.3949/ccjm.77a.09103. Diet can be more lenient than in the past, p. 873
Source: https://www.poison.org/articles/making-sense-of-mao-inhibitors See bottom of page.
Edited by s240779 (12/15/24 07:46 AM)
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