FOOD INTOLERANCE NETWORK FACTSHEET
migraines, depression and other symptoms
a possible link with schizophrenia
Keywords: amine, migraines, depression
All foods are made up of hundreds of naturally occurring compounds that can have varying effects on us, depending on how much we eat and how sensitive we are.
Biogenic amines are formed by the breakdown of proteins in foods. They can affect mental functioning, blood pressure, body temperature, and other bodily processes. Some hormones, such as adrenaline (epinephrine) are compounds containing an amine. There are many different amines, including:
- tyramine (e.g. in cheese)
- histamine (e.g. in wine)
- phenylethylamine (e.g. in chocolate)
- agmatine, putrescine, cadaverine, spermidine (e.g. in decomposing fish)
- adrenaline (ephinephrine)
Biogenic amines are normally quickly broken down in the body with the help of enzymes such as MAO (monoamine oxidase-A) which render them harmless. Missing, sluggish or blocked enzymes can lead to a build up of amines in the body.
The ‘cheese effect’. In people who are taking certain drugs known as MAOIs (monoamine oxidase inhibitors), the enzyme is inhibited and a build up of tyramine can occur, leading to life-threatening high blood pressure as well as a range of symptoms including headaches, itchy skin rashes, heart palpitations and diarrhoea. A number of MAOI patients died from strokes or heart attacks before doctors realised that patients taking MAOIs needed to avoid foods high in tyramine. This is called the ‘cheese effect’ because it was recognised in the 1960s by a British pharmacist who noticed that his wife developed a headache every time she ate cheese - high in tyramine - while taking MAOI antidepressants.
Lacking the enzyme. There is a rare condition in which people who are born without the MAOA gene lack the MAO enzyme. Researchers have long known that this condition is associated with aggression in men.
Low activity enzyme. Much more common is a low activity variant of the gene known as MAOA-L, which seems to occur in about one third of the population. A study with nine uncontrollable children in 1985 found that on average there was five times more para-cresol in their faeces than for a control group. Para-cresol is a breakdown product of tyramine. Could it be that these children were failing to metabolise dietary tyramine due to a sluggish enzyme? We don’t know because the study was never followed up, although the researchers commented that ‘the results point to dietary involvement’. In 2002, a study found that men with MAOA-L who had been badly treated as children were more likely to exhibit antisocial behaviour than those who had been well treated.
Behavioural effects fit with what we see in the Food Intolerance Network. Children with oppositional defiance are the ones whose parents are often told ‘he just needs a good smack’. But smacking has the opposite effect – if you smack these kids, when they are big enough they will hit you back. Or if they are scared of their parents, they will hit other people, and this is defined as conduct disorder. You have to treat these kids as if they are your friend – a calm approach – and avoid backing them into a corner at all times. It can be difficult to maintain a calm approach with someone who is extremely aggressive, and experts acknowledge that this approach has limited success. Network members find that it is easier to avoid the food chemicals that cause these effects.
Research suggests that about 70 per cent of children with behaviour problems are affected by salicylates, artificial colours and preservatives, compared to only about 40 per cent affected by amines. Many mothers have reported that their child becomes silly and hyperactive on salicylates whereas amines make them aggressive. In our experience, children who are expelled from day care centres due to aggressive behaviour are usually sensitive to amines as well as to other food chemicals.
Migraines, depression and other symptoms
A possible link with schizophrenia
A biogenic amine called dimethyltriptamine (DMT for short) is the only known hallucinogenic compound naturally produced by the body. Normally it is metabolised by the monoamine oxidase enzyme before its effects can be noticed. It is used in tribal and religious rites in South America by combining a naturally rich source of DMT with a natural MAO inhibitor while avoiding tyramine containing foods, usually through fasting. DMT is present in small amounts in a wide range of animal and plant foods and mushrooms. In the 1950s, researchers suggested that the schizoid symptoms of auditory or visual hallucinations could be due to an inborn deficit in the MAO enzyme, allowing small amounts of DMT from foods to build up in the body. This theory is once again becoming popular. It would account for why some failsafers have reported that schizoid symptoms improve on a low chemical elimination diet.
 Amines are the really big problem (August 2006)
My 14 year old son goes off his face with food colouring but it only lasts a couple of hours so we can put up with that. Salicylates aren’t too bad either, at home, although it must be terrible at school. He gets bouncy and silly. In class he wouldn’t be able to sit still or listen to the teacher. He would be too busy poking and prodding the kid next to him. Amines are the really big problem though. When he eats amines it’s World War III at our place. We need an air-raid siren. He’ll get up in a foul mood, kick the wall, swear, throw things, yell. Absolutely revolting. After we started the elimination diet we had five months of a perfect child but when we started our challenges that was the end of our wonderful existence. With his amine challenge he took nearly four weeks to calm down again.
 World war three (August 2001)
I contacted a dietitian through the Base hospital and with their help we managed to get through the Elimination Diet. ... We both reacted to amines and our symptoms were the same and severe - aggressive behaviour with a lack of self-control, depression etc. It was like world war three in our house by the end of the week and both of us took at least a week to recover …
 Amines and eczema (August 2006)
I am now 46, and have lived for most of those years with dreadful eczema all over my body, some times much worse than others. I went to many skin specialists, all who told me that diet was not linked, not to scratch, bathe in the sea when possible, not to use harsh soaps and apply cortisone creams. My eczema never got any better. I started the elimination diet a few years ago with my daughter, who suffers migraines, and not only did her headaches decrease, but my eczema also faded to almost nothing! Amines were the trigger for her migraines, and with keeping off amine rich foods in our house, I have not had any eczema problems since, and I no longer need to apply creams to any parts of my body. What a relief!
 Amines: depression and hungover (August 2006)
This father who was doing the elimination diet to support his son chose to do the amine challenge first because he thought he wouldn’t react. ‘How wrong can you get!’ he wrote in his account of the challenge:
'I had a violent reaction within a few hours and have never felt so awful in all my life. Here are some of the symptoms: depression, suicidal tendencies not just thoughts, melancholy, looking for an argument, feeling the whole world was against me, lethargy, shakes, pressure on the skull and tingles in the extremities, feeling of hangover, inability to focus on thoughts, ringing in the ears, inability to sleep. The hungover feeling lasted until the next day. Not the best 24 hours but at least I know there is a cause for symptoms that I have experienced in the past.’
 Amine-related migraines since the age of 3 (March 2006)
My 7 year old daughter Caitlin (not her real name) has had migraines since she was about 3 years old. We had no idea what they were for several years. She usually gets a fever with her migraines and because of the fever the doctor would always put it down to a virus, prescribing painkillers. I would often give her panadol for 4 days straight just to keep the headaches at bay. She goes limp and listless, her eyes always droop, she lies there and sleeps for hours until the panadol wears off and then the pain and fever return. Most times she will scream and cry, grabbing her forehead and pleading with me to take the pain away, “Mummy Mummy my heads hurts, please stop it.” She has always complained of feeling sick (nausea) when she gets them too, and ‘sore legs’. As well, she has had problems with nasal congestion and had been using Rhinocourt nasal spray daily. She has always been a nail biter and a teeth grinder at night.
One year after she started getting the migraines, we were referred to a pediatrician who could find no medical reason for them either. He thought it may have been an attention grabber or perhaps the start of a cold. The migraines continued on and off with no regular pattern that I could work out, once a week, then maybe another in 6 weeks times, then 2 months. It varied greatly.
Two years later we started taking a fish oil Supplement called ‘Eye-q’. (I later found ‘Eye-q’ has amines in it). The migraines became more frequent and she started throwing up with them. She would go to sleep with a migraine and wake at 3 am and throw up in bed or the bath (with the migraine and fever). I said enough!! No more Panadol, Nurofen or Painstop! This time her pediatrician ordered a cat scan which was clear. He offered my 6yr old a daily dose of betablockers or a trial using riboflavins or diet manipulation …guess which one we chose?
We have been eating failsafe since about March this year and have never looked back. On day 2 of the amine challenge, Caitlin got a migraine, droopy eyes, became listless, and a fever. School rang and asked me to collect her again. She stayed unwell for several days with the headache.
During the challenge, she also got a blocked nose, sore tummy, sore nose, nightmares and was badly constipated. Since the end of the amine challenge (3 months ago) we haven’t had one migraine! No more snotty nose or blocked nose, nasal sprays, nightmares, sore tummies, nail biting, teeth grinding, or sore legs - her nails are growing for the first time in her life. So, no more amines for Caitlin! – by email, NSW
Amine levels in different foods
Fish, cheese, wine, some meats, some fruit such as bananas and avocados, some vegetables such as mushrooms, and fermented foods such as chocolate, sauerkraut and soy sauce are just some of the foods that have been listed as containing varying levels of amines, but basically any protein food can contain amines depending on the way it is handled. The amine content of foods varies greatly due to differences in processing, age, ripeness, handling, storage, variety of grapes or other produce, cooking method and many other factors. An Australian analysis of the amine contents of fish-based oriental sauces found up to 6 times the legal limit of histamines in some of the samples. Freshness is a key factor for avoiding amines. The new method of meat distribution in our supermarkets is a problem for amine responders. All meat is now vacuum packed, repacked and sold as fresh which means it can be up to ten weeks old when you eat it. Studies show that vacuum packing can inhibit the growth of bacteria but does nothing to retard the development of amines.
Many drugs can contain amines, including over the counter cold tablets, decongestants, nasal drops or sprays, some pain relievers, general and local anaesthetics and some antidepressants.
In 1996, researchers in a medical journal reported a more user-friendly MAOI diet based on laboratory analyses, claiming that many dietary restrictions were not necessary. Doctors on an internet forum were reluctant about advising patients to relax their diets. ‘It is easy but is it safe?’ asked one. Another reported a patient whose diet infringement with a now supposedly safe food resulted in headaches, high blood pressure and seizures.
Experience suggests that people who are sensitive to amines need to know a lot of about the history and freshness of their foods and approach all possible amine-containing foods with caution. Lists of amine-containing foods (such as the one on the World Headache Alliance website) are not complete from our point of view. People with migraines who have avoided some amine-rich foods often say ‘I tried avoiding foods and it didn’t work’. This is because migraines can be provoked by many other amine-containing foods and/or other food chemicals such as additives, salicylates and glutamates. For recipes that are free of additives and low in salicylates, amines and flavour enhancers, see our recipes page.
Abstracts for most of the papers below can be found in PubMed, the medical database.
Adams RF, Murray KE, Earl JW. High levels of faecal para-cresol in a group of hyperactive children. Lancet 1985;2(8467):1313.
Alberti A, Pirrone P, Elia M, Waring RH, Romano C. Sulphation deficit in "low-functioning" autistic children: a pilot study. Biol Psychiatry 1999;46(3):420-4.
Breakey J, Hill M, Reilly C, Connell H. A report on a trial of the low additive, low salicylate diet in the treatment of behaviour and learning problems in children. Aust J Nutr Diet 1991;48(3):89-94. (Certain amine containing foods such as chocolate were also excluded).
Caspi A, McClay J, Moffitt TE, Mill J, Martin J, Craig IW, et al. Role of genotype in the cycle of violence in maltreated children. Science 2002;297(5582):851-4.
Clarke L, McQueen J, Samild A, Swain A. The dietary management of food allergy and food intolerance in children and adults. Australian Journal of Nutrition and Dietetics 1996;53(3):89-94.
den Brinker C, Rayner C, Kerr M. Investigation of biogenic amines in fermented fish and fish products. Food Safety Unit, Public Health Division, Department of Human Services, State of Victoria, 2002. Free full text at www.foodsafety.vic.gov.au.
Fonberg-Broczek M, Sawilska-Rautenstrauch D. Level of histamine and tyramine in ripening cheeses. Rocz Panstw Zakl Hig 1995;46(3):243-6. Abstract only.
Gardner DM, Shulman KI, Walker SE, Tailor SA. The making of a user friendly MAOI diet. J Clin Psychiatry 1996;57(3):99-104.
Hauser MJ, Baier H. Interactions of isoniazid with foods. Drug Intell Clin Pharm 1982;16(7-8):617-8.
Kim-Cohen J, Caspi A, Taylor A, Williams B, Newcombe R, Craig IW, et al. MAOA, maltreatment, and gene-environment interaction predicting children's mental health: new evidence and a meta-analysis. Mol Psychiatry 2006. Molecular Psychiatry advance online publication, 27 June 2006; doi:10.1038/sj.mp.4001851.
Klausen NK, Lund E. Formation of biogenic amines in herring and mackerel. Z Lebensm Unters Forsch 1986;182(6):459-63.
Landete JM, Ferrer S, Polo L, Pardo I. Biogenic amines in wines from three Spanish regions. J Agric Food Chem 2005;53(4):1119-24.
Loblay RH, Swain AR. 'Food intolerance'. In Wahlqvist ML, Truswell AS, Recent Advances in Clinical Nutrition. London: John Libbey, 1986, pages 169-177. 1986.
Maga JA. Amines in foods. CRC Crit Rev Food Sci Nutr 1978;10(4):373-403.
McCabe BJ. Dietary tyramine and other pressor amines in MAOI regimens: a review. J Am Diet Assoc 1986;86(8):1059-64.
Meyer-Lindenberg A, Buckholtz JW, Kolachana B, A RH, Pezawas L, Blasi G, et al. Neural mechanisms of genetic risk for impulsivity and violence in humans. Proc Natl Acad Sci U S A 2006;103(16):6269-74.
Millichap JG, Yee MM. The diet factor in pediatric and adolescent migraine. Pediatr Neurol 2003;28(1):9-15.
Mirchandani H, Reich LE. Fatal malignant hyperthermia as a result of ingestion of tranylcypromine (Parnate) combined with white wine and cheese. J Forensic Sci 1985;30(1):217-20.
Morinaga S, Kawasaki A, Hirata H, Suzuki S, Mizushima Y. Histamine poisoning after ingestion of spoiled raw tuna in a patient taking isoniazid. Intern Med 1997;36(3):198-200.
Nadon CA, Ismond MA, Holley R. Biogenic amines in vacuum-packaged and carbon dioxide-controlled atmosphere-packaged fresh pork stored at -1.50 degrees C. J Food Prot 2001;64(2):220-7.
Parker G, Watkins T. Treatment-resistant depression: when antidepressant drug intolerance may indicate food intolerance. Aust N Z J Psychiatry 2002;36(2):263-5.
Pomilio AB, Vitale AA, Ciprian-Ollivier J, Cetkovich-Bakmas M, Gomez R, Vazquez G. Ayahoasca: an experimental psychosis that mirrors the transmethylation hypothesis of schizophrenia. J Ethnopharmacol 1999;65(1):29-51.
People have different reactions to various food chemicals. Some people are affected by any or all of the following foods and food chemicals: artificial colours, natural colour annatto 160b, preservatives, synthetic antioxidants, flavour enhancers, salicylates, amines, dairy foods, wheat, gluten.
The information given is not intended as medical advice. Always consult with your doctor for underlying illness. Before beginning dietary investigation, consult a dietician with an interest in food intolerance. You can see our list of experienced and supportive dietitians http://fedup.com.au/information/support/dietitians
© Sue Dengate Update August 2006