Biogenic Amines in Foods & MAOI Drugs

Biogenic Amines in Foods & MAOI Drugs
A Crossroads Where Medicine, Nutrition, Pharmacy, and Food Industry Converge
Authors
* Beverly J. McCabe-Sellers, PhD, RD, LD
* Cathleen Staggs, MS
* Margaret L. Bogle, PhD, RD, LD
* Lower Mississippi Delta Nutrition Intervention Research Initiative
* Little Rock, AR 72211

Biogenic Amines in Foods
* What are Biogenic Amines (BAs)?
* What are MAOI drugs?
* Why be concerned?
* What are the problems in establishing BA content of foods?
* Why is interdisciplinary collaboration essential?

Biogenic Amines
* Organic bases usually produced by decarboxylation of amino acids or by amination and transamination of aldehydes and ketones.
* Vasoactive or psychoactive amines.
Decarboxylation Reactions: Free Amino Acid to Biogenic Amine

* Histidine
* Arginine
* Phenylalanine
* Tyrosine
* Tryptophan
* Histamine
* Putrescine
* 1-phenylethylamine &
* Tyramine
* Tryptamine
Vasoactive Pressor Amines
* Tyramine
* Tryptamine
* phenylethylamine

Tyramine:Physiological Effects
* Peripheral vasoconstriction
* Increased cardiac output
* Increased respiration
* Elevated blood sugar
* Release of norepinephrine

Tyramine Detoxification
MAOI Drugs
* Used to inhibit the actions of Monoamine Oxidase, especially in CNS as antidepressant
* More effective than other antidepressants in some subgroups, e.g. anxiety depressions, older adults
Tyramine and the Cheese Reaction
Foods with Tyramine
Banana pulp or Banana Peel
Potential for Tyramine Formation
Fermented: Sauerkraut
Mushrooms: Long storage, temperature abuse.
Questions about Early Analyses
Review of Published Values
* 289 food values and 108 alcoholic beverage values since 1981
* 15 (6%) foods were deliberately aged
* 65 (22%) contained sufficient tyramine to induce clinical reaction if 1-2 servings were consumed....

Food Science has brought us….
* Better technology to detect BA
* Food handling processes = improves food
* Over 100 articles addressing methods/processes of detecting or preventing tyramine development.
Newer generations and new modes of administration that lower the risks for food-drug interaction.
* Selective reversible MAOIs allow treatment of Parkinson Disease with little risk of hypertensive crisis.

Pharmaceutical Advances
Science promises….
Nutritionists bring….
Best Dietary Advice with MAOIs
* Buy fresh.
* Cook fresh
* Eat fresh

Biogenic Amines in Foods & MAOI Drugs.ppt

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Grapefruit Juice: Interactions with Prescription Drugs

Grapefruit “Juicy” Details on Health Benefits and Drug Interactions
Presentation by:Elaine Turner & Gail Rampersaud, FSHN
University of Florida

Grapefruit Juice: Interactions with Prescription Drugs
Grapefruit Juice: What’s the Story?

Some pills become too potent when you drink grapefruit juice Grapefruit juice and drugs don’t mix
Forbidden Fruit? Grapefruit Juice-Medicine Interaction Studied Grapefruit Takes the Defense Sex, drugs, and grapefruit

Food/Drug Interactions
Food can affect:
* absorption
* utilization
* excretion
Influence can be:
* positive
* negative

Effects of Grapefruit Juice Enhances Absorption
* inhibits an intestinal enzyme
* less metabolism in GI tract
* like giving larger dose

Normal Drug Metabolism
ORAL DOSE
ENZYME
LIVER
GI TRACT
BLOOD
Effect of Grapefruit Juice
Enzyme Inhibition
Effects of Grapefruit Juice
Are All Drugs Affected? – no!

* oral medications only
* low bioavailability
* amount of effect varies

Which Types of Drugs are Affected?
* Antihypertensives
* Immunosuppressants
* “Statins”
* Anti-anxiety, Antidepressants
* Antihistamines
* HIV/AIDS protease inhibitors

Which Types of Drugs are Affected?
* Usually an alternative drug is available
o e.g., Pravachol instead of Lipitor

Consumer Actions
Ask Pharmacist:
Consumer Actions
Ask Physician:
Take Home Message
Media Statements:

* Usually too general
* Talk with pharmacist and physician
* May not need to avoid grapefruit juice

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Nutrient-drug interaction

Nutrient-drug interaction
Presentation by:Dr. Wassef
Department of Food Science

Definition of drug
* Medicine that helps recover from illness
* Illegal substance that leads to bodily harm and addiction
* Any substance that modifies one or more body functions

Multiple effects of drugs
* For example, Aspirin….
* Limits production of prostaglandins
* Prostaglandins help to produce fevers, sensitize pain receptors, cause contractions of the uterus, stimulate digestive tract motility, control nerve impulse, regulate blood pressure, promote blood clotting, cause inflammation.
* By interfering with prostaglandin actions, aspirin may have multiple effects!
* Nutrient-drug interaction can lead to nutrient imbalance or it can interfere with drug effectiveness
* Adverse interactions occur most likely if drugs are taken over long periods, if several drugs are taken or if nutrition status is poor
* Elderly people with chronic diseases are most vulnerable

Action of a Drug

o Dissolve in stomach
o Absorbed in blood and moves to where needed
o Has a reaction
o Eliminated

Action of a Food/Nutrients
o Digestion in stomach
o Absorbed in blood and moves to where needed
o Has a reaction/stored
o Not needed is Eliminated

Type of interactions
* Drugs can alter food intake, absorption, metabolism and excretion of nutrients
* Foods and nutrients can alter absorption, metabolism and excretion of drugs

Mix Food, Drink and Drugs Carefully
* Ask doctor questions
* Talk to pharmacist
* Read medicine labels
* Read printed material from pharmacy
* Read inserts provided by manufacturers

Nutrient-Drug Interactions
KNOW YOUR DRUG
Don’t mix a drug directly into a food or drink
Know Whether the Drug Should Be Taken on a Full or Empty Stomach
A New Concern - Grapefruit
* Can cause more of a drug to be absorbed from intestine – even toxic levels
* Interfere with the activity of a specific enzyme in the intestine – cytochrome

Drugs may not work when dairy products are consumed
* Tetracycline (also no iron supplements)
* Antifungal medicines
o Examples Diflucan and Nizoral
Drugs may require dairy products to work
* Progesterone supplementation

High Blood Pressure Medicine
* May need more or less potassium in your diet depending on the medicine
* Examples of high potassium foods – bananas, oranges, potatoes, leafy green vegetables, tomatoes

Coumadin and Vitamin K structural analog
* Coumadin prevents clots; Vit K helps to make clots
* Keep intake of foods containing Vitamin K constant
* Vitamin K is high in spinach, kale, turnip greens, cauliflower, broccoli, brussel sprouts and other leafy greens
* Also don’t take Vitamin K or E supplements

Used in cancer therapy
Displaces folate (antagonist) and causes folate deficiency
Methotrexate
Folate
Tyramine found in some food.
Monoamine oxidase inhibitors (MAOi)
MOA Inhibitors
Coumadin – blood thinner
Dilaritin – anti-seizure
Norvasc – anti-hypertension
Aspirin/Anti-inflammatory
Oral Contraceptives
Dyazide – diuretic
Tetracycline – Antiboitic
Lipitor/Statin – Cholesterol lowering
Prednisone – corticosteroid
Lasix - diuretic
DRUG
NUTRIENT/FOOD
Vitamin K
Vitamin D and Folate Deficiency
Sodium
Decrease Vitamin C
Decrease Vitamin B and folate
Decrease Potassium
Calcium
Antioxidants (Vitamin A, E, C)
Increase Appetite
Take NO Medicines with Alcohol
Alcohol & Pain Medicine
* Don’t take with alcohol to prevent stomach bleeding and irritation
* Don’t have more than 3 drinks per day to prevent liver damage if taking Tylenol
* Interact with enzymes – reducing effect of medicine
* Compete – leaving the drug longer - toxic
Alcohol & Other Medicines
* Can lower blood pressure too much with beta blockers and nitrate containing drugs
* Can cause liver damage with statin drugs
* Beta blocker – Inderal, Lopressor
* Nitrates – Nitro, Transderm Nitro, Isordil
* Statins – Lipitor, Mevacor, Zocor, Prevachol

Alcohol & Medicines for Depression and Anxiety
* Never mix with alcohol with any of these drugs! – make you more depressed and anxious
* Also caffeine may decrease the effectiveness of anti-anxiety drugs

Medicines may contain additional ingredients…..
The health-professional and nutrient-drug interactions
In Summary

* Tell your doctor and pharmacist about all your medicines
* Take your medicines to every doctor visit
* Learn all you can about your drugs
* Use alcohol and caffeine very cautiously if at all
* Drink plenty of water

Pharmacogenomics
Everybody is different
The Right Drug
To The Right Patient
For The Right Disease
At The Right Time
Goals of Pharmacogenomics

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