Tyramine
Tyramine , also known under several other names, is a naturally occurring trace amine derived from the amino acid tyrosine. Tyramine acts as a catecholamine releasing agent. Notably, it is unable to cross the blood-brain barrier, resulting in only non-psychoactive peripheral sympathomimetic effects following ingestion. A hypertensive crisis can result, however, from ingestion of tyramine-rich foods in conjunction with the use of monoamine oxidase inhibitors.
Occurrence
Tyramine occurs widely in plants and animals, and is metabolized by various enzymes, including monoamine oxidases. In foods, it often is produced by the decarboxylation of tyrosine during fermentation or decay. Foods that are fermented, cured, pickled, aged or spoiled have high amounts of tyramine. Tyramine levels go up when foods are at room temperature or go past their freshness date.Specific foods containing considerable amounts of tyramine include:
- strong or aged cheeses: cheddar, Swiss, Parmesan; Stilton, Gorgonzola or blue cheeses; Camembert, feta, Muenster. Cheeses made from pasteurized milk are lower in tyramine: American, ricotta, cottage, farmer's, and cream cheese. Other dairy products are also lower in tyramine: yogurt, fresh milk, sour cream, soy cheese, soy milk, Harvati cheese, Brie.
- meats that are cured, smoked or processed, such as salami, pepperoni, dry sausages, hot dogs, bologna, bacon, corned beef, pickled or smoked fish, caviar, aged chicken livers, soups or gravies made from meat extract. Some meat products are lower in tyramine: fresh or frozen meat, poultry, and fish; eggs; canned meats or fish freshly opened; luncheon meats except salami.
- pickled or fermented foods: sauerkraut, kimchi, tofu, pickles, miso soup, bean curd, tempeh
- condiments: soy, shrimp, fish, miso, teriyaki, and bouillon-based sauces. Lower in tyramine: ketchup, mustard, Worcestershire sauce, salad dressing; vegemite, Pro-mite, marmite
- drinks: beer, vermouth, red wine, sherry, liqueurs. Lower in tyramine: decaffeinated coffee, tea or soda; club soda; fresh or soy milk; bourbon; gin; rum; vodka
- beans, veggies and fruits: soybeans and soybean products, snow peas, broad beans and their pods; raw onions; oranges, grapefruit, lemons, limes, tangerines, pineapple. Lower in tyramine: most fresh, canned or frozen veggies; raisins. Raspberries and avocados have moderate levels.
- chocolate and the holiday plant mistletoe
Physical effects and pharmacology
Evidence for the presence of tyramine in the human brain has been confirmed by postmortem analysis. Additionally, the possibility that tyramine acts directly as a neuromodulator was revealed by the discovery of a G protein-coupled receptor with high affinity for tyramine, called TAAR1. The TAAR1 receptor is found in the brain, as well as peripheral tissues, including the kidneys. Tyramine binds to both TAAR1 and TAAR2 as an agonist in humans.Tyramine is physiologically metabolized by monoamine oxidases, FMO3, PNMT, DBH, and CYP2D6. Human monoamine oxidase enzymes metabolize tyramine into 4-hydroxyphenylacetaldehyde. If monoamine metabolism is compromised by the use of monoamine oxidase inhibitors and foods high in tyramine are ingested, a hypertensive crisis can result, as tyramine also can displace stored monoamines, such as dopamine, norepinephrine, and epinephrine, from pre-synaptic vesicles. Tyramine is considered a “false neurotransmitter,” as it enters noradrenergic nerve terminals and displaces large amounts of norepinephrine, which enters the blood stream and causes vasoconstriction.
The first signs of this effect were discovered by a British pharmacist who noticed that his wife, who at the time was on MAOI medication, had severe headaches when eating cheese. For this reason, it is still called the "cheese effect" or "cheese crisis," though other foods can cause the same problem.
Most processed cheeses do not contain enough tyramine to cause hypertensive effects, although some aged cheeses do.
A large dietary intake of tyramine can cause the tyramine pressor response, which is defined as an increase in systolic blood pressure of 30 mmHg or more. The increased release of norepinephrine from neuronal cytosol or storage vesicles is thought to cause the vasoconstriction and increased heart rate and blood pressure of the pressor response. In severe cases, adrenergic crisis can occur. Although the mechanism is unclear, tyramine ingestion also triggers migraine attacks in sensitive individuals. Vasodilation, dopamine, and circulatory factors are all implicated in the migraines. Double-blind trials suggest that the effects of tyramine on migraine may be adrenergic.
Research reveals a possible link between migraines and elevated levels of tyramine. A 2007 review published in Neurological Sciences
presented data showing migraine and cluster diseases are characterized by an increase of circulating neurotransmitters and neuromodulators in the hypothalamus, amygdala and dopaminergic system. People with Migraine are over-represented among those with inadequate natural monoamine oxidase, resulting in similar problems to individuals taking MAO inhibitors. Many migraine attack triggers are high in tyramine.
If one has had repeated exposure to tyramine, however, there is a decreased pressor response; tyramine is degraded to octopamine, which is subsequently packaged in synaptic vesicles with norepinephrine. Therefore, after repeated tyramine exposure, these vesicles contain an increased amount of octopamine and a relatively reduced amount of norepinephrine. When these vesicles are secreted upon tyramine ingestion, there is a decreased pressor response, as less norepinephrine is secreted into the synapse, and octopamine does not activate alpha or beta adrenergic receptors.
When using a MAO inhibitor, an intake of approximately 10 to 25 mg of tyramine is required for a severe reaction, compared to 6 to 10 mg for a mild reaction.
Biosynthesis
Biochemically, tyramine is produced by the decarboxylation of tyrosine via the action of the enzyme tyrosine decarboxylase. Tyramine can, in turn, be converted to methylated alkaloid derivatives N-methyltyramine, N,N-dimethyltyramine, and N,N,N-trimethyltyramine.In humans, tyramine is produced from tyrosine, as shown in the following diagram.
Chemistry
In the laboratory, tyramine can be synthesized in various ways, in particular by the decarboxylation of tyrosine.Legal status
United States
Tyramine is not scheduled at the federal level in the United States and is therefore legal to buy, sell, or possess.Status in Florida
Tyramine is a Schedule I controlled substance, categorized as a hallucinogen, making it illegal to buy, sell, or possess in the state of Florida without a license at any purity level or any form whatsoever. The language in the Florida statute says tyramine is illegal in "any material, compound, mixture, or preparation that contains any quantity of or that contains any of salts, isomers, including optical, positional, or geometric isomers, and salts of isomers, if the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation."This ban is likely the product of lawmakers overly eager to ban substituted phenethylamines, which tyramine is, in the mistaken belief that ring-substituted phenethylamines are hallucinogenic drugs like the 2C series of psychedelic substituted phenethylamines. The further banning of tyramine's optical isomers, positional isomers, or geometric isomers, and salts of isomers where they exist, means that meta-tyramine and phenylethanolamine, a substance found in every living human body, and other common, non-hallucinogenic substances are also illegal to buy, sell or possess in Florida. Given that tyramine occurs naturally in many foods and drinks, e.g. wine, cheese, and chocolate, Florida's total ban on the substance may prove difficult to enforce.