Along with my weight loss journey, I have made some other dietary changes. One of the big ones and an enabler to getting off of Metoprolol was changing my diet to avoid or at least reduce my consumption of Tyramines. Another, was to raise my protein intake as a percentage of diet.
What do Migraines and Heart Palpitations have as common triggers?
- Tyramines
- Here is an article on this topic. https://www.fmptr.com/The-Impact-of-Tyramine-on-Heart-Palpitations–Understanding-the-Risks-and-Precautions
- And another old one: https://pmc.ncbi.nlm.nih.gov/articles/PMC1277109/ It covers Afib rather than the PACs (Premature Atrial Contractions). However untreated recurrent PACs can progress to Afib which I definitely want to avoid.
Let me go back a bit. I have long loved big salads for lunch or dinner. As a youth and young adult, Perkins, Rocky Rococco and Sizzler were favorites for salad bars. I would pile the plate high with lots of goodies to get my “money’s worth”. Chancery was another local favorite for their big dinner salads. I loved these huge salads. However they were calorie bombs and the meats, cheeses and some of the greens on them presented a few problems. Fast forward to early 2020 and I was having salads for lunch, of nearly the same proportions and with home made charcuterie, even more aged cheese, garden produce and some good crunchies. Often I would lie down for a nap after lunch (yes, retired papas get to nap when the grand kids do). However, I would get heart palpitations. At first I brushed it off thinking it was just that I was quietly resting. However it continued and got worse over the next year. Early in 2021, I went in to the hospital and had cardiac tests (echo, stress nuc, heart cath, holter monitor). It was not just for fun. Cardiac function was basically fine, one small stenosis and now I was on 3 drugs to help reduce the blood pressure and control the palpitations.
The meds helped. BP went down, palpitations were less frequent but not eliminated. The palpitations were also worse in the summer (more heaping salads). I was starting to make the connection but it still eluded me. I did find some articles on “Holiday Heart syndrome” which could explain the end of vacation and Christmas holiday increases in frequency due to alcohol consumption. See: https://health.stonybrookmedicine.edu/holiday-heart-syndrome-risks-and-prevention/. Then I came across some journal articles on tyramines and the link to arrhythmias, notably Afib. These were almost an afterthought as the original concept in some of the articles was to prove the link of tyramine consumption and migraines. However the heart palpitation issues kept cropping up alongside in their studies.
So what could possibly be in my salads? It turns out a lot. I like flavorful salads, so there are a lot of goodies. Not all salads would have everything, but there were trade offs (e.g. anchovies vs lonzino -cured pork loin). A typical salad would have: lettuce or spinach, tomatoes, onions, cheese (e.g. aged cheddar, blue, parmesan or romano ), meat (ham, lonzino, speck or parma ham, pepperoni, soppresetta, or anchovies), snow pea pods, peppers, blue cheese or caesar dressing, toasted soy nuts or sunflower seeds and avocado. This was often accompanied by some of my home made sourdough bread.
At this time, I was making my own dry cured meats such as the lonzino, speck, bressaola, soppresetta, pepperoni. These were carefully done and had less fat, salt and nitrites than commercial versions (including the “uncured” nonsense products). However, what I did not understand at the time was most of these items are high in tyramines. The tyramines are formed as the proteins break down during the aging process (which leads to some of the wonderful flavors of these aged and fermented foods). In addition, some just occur naturally in fresh foods. You can see crystals containing tyrosine on the cut ends of cured and dried meats such as lonzino or bressaola. Tyrosine is converted into Tyramine after it has been eaten. Similarly home made beer and fermented pickles (both of which I make) also are notable for high tyramine levels.
Here are some great resources on tyramine containing foods:
- This is my favorite and is printed out and resides on the side of the fridge. https://fdnow.org/wp-content/uploads/2020/01/Tyramine-Free-Food-List-for-Website-updated-January-2020.pdf
- A good over view on tyramines and the food types that contain it: https://foodfornet.com/tyramine-rich-foods/
- Here is one on amines including tyramines in beer and brewing. Note the most flavorful (e.g. aged, double fermented) beers (which I like to make) have the highest tyramine levels. Note also the histamine levels which is why having some cold ones in peak allergy season may be problematic. https://suigenerisbrewing.com/index.php/2019/01/22/biogenic-amines/
- Here is another that talks about the links of tyramines to migraines as well. https://www.webmd.com/diet/foods-high-in-tyramine
- One more site with a series of articles on the topic: https://roguescientist.co/category/tyramine/
Based on my experience, I can tolerate moderate amounts, but my lunch salads definitely put me into a tyramine overload situation and the heart palpitations would start 30-60 minutes later. The list of items for my salads that had the high tyramine items in the list above are in BOLD. Now my salads have a shorter list of goodies on them. I have greatly curtailed my cured meat and charcuterie production because of this. Switching from from sourdough bread, sharp cheddar spread cheese and peanut butter for breakfast to yogurt with protein powder and fruit has also helped.
With these changes, I have reduced my PACs from occurring several times each week to once very briefly in the last 10 months. I still get to enjoy good beer and red wine in moderation. I also get to enjoy some (just fewer) items out of the high tyramine content / avoid listings.
Mark Bronkalla