(Foods that have possible contraindications with our tea)

Tyramine is an amino acid that is found in various foods and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. Monoamine oxidase is found in the gastrointestinal tract and inactivates tyramine; when drugs prevent the catabolism of exogenous tyramine, this amino acid is absorbed and displaces norepinephrine from sympathetic nerve ending and epinephrine from the adrenal glands.

If a sufficient amount of pressor amines are released, a patient may experience a severe occipital or temporal headache, diaphoresis, mydriasis, nuchal rigidity, palpitations, and the elevation of both diastolic and systolic blood pressure may ensue (Anon, 1989; Da Prada et al, 1988; Brown & Bryant, 1988).

On rare occasions, cardiac arrhythmias, cardiac failure, and intracerebral hemorrhage have developed in patients receiving MAOI therapy that did not observe dietary restrictions (Brown & Bryant, 1988).

Therefore, dietary restrictions are required for patients receiving MAOIs. Extensive dietary restrictions previously published were collected around 1976 and due to changes in food processing and more reliable analytical methods, new recommendations have been published (Anon, 1989; McCabe, 1986).

The tyramine content of foods varies greatly due to the differences in processing, fermentation, ripening, degradation, or incidental contamination. Many foods contain small amounts of tyramine and the formation of large quantities of tyramine have been reported if products were aged, fermented, or left to spoil.

Because the sequela from tyramine and MAOIs are dose-related, reactions can be minimized without total abstinence from tyramine-containing foods. Approximately 10 to 25 mg of tyramine is required for a severe reaction compared to 6 to 10 mg for a mild reaction. Foods that normally contain low amounts of tyramine may become a risk if unusually large quantities are consumed or if spoilage has occurred (McCabe, 1986).

Three lists were compiled (foods to avoid, foods that may be used in small quantities, and foods with insufficient evidence to restrict) to minimize the strict dietary restrictions that were previously used and improve compliance and safety of MAOI therapy. The foods to avoid listed below consist of foods with sufficient tyramine (in small or usual serving sizes) that would create a dangerous elevation in blood pressure and therefore should be avoided (McCabe, 1986).

Foods to Avoid

• All Alcoholic beverages, including Non-alcoholic beverages (alcohol-free beer and wines), may contain tyramine and should be avoided (Anon, 1989; Stockley, 1993).

• Fermented and non-fermented bean curd, fermented soya bean, and soya bean pastes contain a significant amount of tyramine (Anon, 1989).

• Broad (fava) bean pods - These beans contain DOPA, not tyramine, which is metabolized to dopamine and may cause a pressor reaction and therefore should not be eaten, particularly if overripe (McCabe, 1986; Anon, 1989; Brown & Bryant, 1988).

• Cheese - Tyramine content cannot be predicted based on appearance, flavour, or variety and therefore should be avoided. (Cream cheese and cottage cheese are OK) (McCabe, 1986; Anon, 1989, Brown & Bryant, 1988).

• Fish - Smoked, fermented, pickled (Herring) and otherwise aged fish, meat may contain high levels of tyramine and should be avoided (Anon, 1989; Brown & Bryant, 1988).

• Ginseng - Some preparations have resulted in a headache, tremulousness, and manic-like symptoms (Anon, 1989).

• Protein extracts - Three brands of meat extract contained 95, 206, and 304 μg/gram of tyramine and therefore meat extracts should be avoided (McCabe, 1986). Avoid liquid and powdered protein dietary supplements (Anon, 1989).

• Meat - Fresh meat is safe, caution is suggested in restaurants (Anon, 1989; Da Prada et al, 1988). Sausage, bologna, pepperoni and salami contain large amounts of tyramine (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).

• Sauerkraut - Tyramine content has varied from 20 to 95 μg/gram and should be avoided (McCabe, 1986).

• Shrimp paste contains a large amount of tyramine (Anon, 1989).

• Soups should be avoided as protein extracts may be present; miso soup is prepared from fermented bean curd and contains tyramine in large amounts and should not be consumed (Anon, 1989).

• Yeast - Brewer's or extracts - yeast extracts (Marmite/ Vegemite) which are spread on bread or mixed with water, Brewer's yeast or Yeast vitamin supplements should not be consumed. The yeast used in baking is safe (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).

How Important are the Food Restrictions before taking Ayahuasca?

The warnings about tyramine interaction sound very serious because they are adapted from warnings about interactions with pharmaceutical MAOIs. There are nearly 100 fatalities on record from food interactions with pharmaceutical MAOIs. However, food interaction with Ayahuasca is frankly not as serious a matter as it is with pharmaceutical MAOIs, because Ayahuasca is a reversible (short-acting) MAOI or RIMA.

There are no fatalities on record from food interactions with Ayahuasca. However, food interaction with Ayahuasca can be unpleasant, manifesting as a headache (which can be severe and may sometimes last for days) or as an uncomfortable rapid heartbeat, and it could conceivably be life-threatening for a person with severe high blood pressure or heart disease.

People with these conditions, therefore, should follow the MAOI safety diet very strictly when taking Ayahuasca. But, except for people with serious heart conditions and/or serious high blood pressure, food interactions with Ayahuasca are not life-threatening, and the effects go away after hours or days with no lasting harm.

(Prescription drugs that have possible contraindications with our tea)

Monoamine oxidase inhibitors (MAOIs) can and will dramatically increase the effects of some of these drugs to the point of becoming dangerous. Other plants and chemicals are intentionally combined with some reversible MAOIs (plants such as Syrian Rue or Banisteriopsis Caapi, or their primary active chemicals the harmala alkaloids) to intentionally increase the effects of chemicals such as DMT (as is done in many forms of the ayahuasca brew) or sometimes phenethylamines such as Mescaline or 2-CB. All of these "potentiating" combinations can be dangerous if used improperly.

To Keep in Mind…

1. The use of this kind of substance usually indicates the presence of symptoms such as anxiety or anguish, panic, unusual fear and insomnia. The presence of these substances in the body together with the tea is not risky.

2. The use of these substances usually indicates epilepsy. In these cases, members and New Participants can drink the tea provided that the seizures are under control. In any case, whether attacks are present or not, only the patient's doctor should stop the medication.

3. These substances indicate the presence of depression or panic disorder. If the drug is being taken in small or medium dosages the risk of interaction with the tea is less significant and the tea can be administered. In all cases, the participant must be closely watched and assisted.

4. In general, this kind of drug indicates psychosis. The candidate to be a New Participant may drink the tea if his condition is under control and the person has regular medical assistance. However, caution is recommended in terms of the volume administered. As to the members, if there is no regular medical assistance, the administration of the tea shall be suspended. The problem is not the interaction of the drugs with the tea but the worsening of the psychosis. If participants have been negatively affected after drinking the tea it is imperative to notify the DEMEC's Mental Health Commission.

5. The use of these substances generally indicates treatment of dependence on alcohol. The participant must be carefully assisted.

6. The use of these substances indicated disorders related to emotion and mood, both euphoria and depression. The tea may be administered, but the participant must be carefully attended to.

7. The simultaneous use of this drug and the tea may present risk. In the case of Members, there is a smaller risk after at least six months of consumption of the

tea. In these situations, it is recommended to reduce the quantity of tea. Regarding New Participants, they will be allowed to drink the tea if the medication is suspended by their private doctor. They should wait at least 2 weeks after the medicine is stopped before the tea is administered.

Some specific pharmaceutical drugs that should not be combined with MAOIs (some are mild risks, others serious):

Avoid the following herbs for at least 48 hours before and after ceremony:

• Betel

• Boswellia

• Carrot seed

• Chamomile

• Cowhage

• Curcumin

• Dill seed

• Ephedra

• Fennel seed

• Fo-Ti

• Ginseng

• Horny Goat Weed

• Kanna

• Kava

• Kratom