Triggers: Tyramine and Alcohol

I would like to share my experience of controlling my aFib by reducing external triggers and am interested to know what others think of my interpretation of these experiences.

Based on what I’ve read in these forums and in Hans Larsen’s book, my aFib is a fairly benign case. I have experienced episodes for about 8 years, but have never been incapacitated by them. Most of my episodes appear vagal, with occasional adrenergic episodes mixed in. They have rarely exceeded 12 to 14 hours in duration. Occasional light headedness but no syncope. Nevertheless I have found them to be very disconcerting.

Over the years episodes have escalated in frequency, and with each escalation I have attempted to moderate the frequency. I had tried eliminating alcohol, caffeine, chocolate to no effect. But magnesium and potassium supplements have had very positive results.

I have seen cardiologists, including one who specializes in arrhythmias. Only treatment recommended so far is aspirin anticoagulation.

During the past year I found episodes increasing in frequency (but not duration) and, after reading up on triggers, tried eliminating high tyramine foods from my diet. I have had very good results with tyramine avoidance. Six months ago I had been having episodes weekly or more often. Now they are about once a month, and almost always associated with a lapse in my tyramine avoidance.

Based on my recent experience I have formed the following hypothesis.

It seems to me that the effect of tyramine containing foods is cumulative. One serving of aged cheese or one avocado salad alone has not caused an episode. I need to have these foods a few days in a row (three or four, even) before it causes an episode. The really interesting thing is that if I’ve had tyramine containing foods over the course of a few days, an episode can be triggered almost immediately by a glass of alcohol (e.g., a large single malt scotch). Alcohol without the tyramine accumulation does not trigger an episode. It’s as if the tyramine effect is slow to accumulate and the alcohol effect is immediate. It’s like tyramine is loading the gun and alcohol is pulling the trigger.

I had one episode recently that makes me wonder about this hypothesis. I had had no tyramine foods for a while, then one night had a good quantity of Italian salami (cured meat). Three days later, I had a scotch at about 9PM and almost immediately had a vagal episode, not very severe in nature but aFib nonetheless. Is it possible that the tyramine lasted in my body for three days before the alcohol triggered it? Or is this a case in which the trigger was alcohol alone?

I am curious to know if anyone else has had this experience of tyramine accumulation with alcohol triggering the episode. And, in general what others think about my conclusions based on my experience.

--Larry

Hi Larry - I have some info for you related to tyramine but am short on time so please be patient and I'll respond to you, hopefully, by tomorrow.

Jackie

Hi Larry,

Interesting topic, I am looking forward to what Jackie has to say.
I know that some alcohol is high in tyramine, not sure about scotch though.
I think alcohol seems to be the trigger but not allways, it's like a buildup of something needs to happen first.

Colin

Hi Larry - Took longer than I thought. Sorry. As Colin mentions, various forms of alcoholic beverages are known to contain tyramine but in the following list quoted, you'll note that's absent. Could be that it was overlooked or perhaps at the time this book was originally published 1987, the details were not updated in the version I have (2003) and there is a newer version 2012 which might have additions to the list. So just consider that the list below merely serves as an awareness notice that some individuals can be totally unaware of this intolerance issue and the connection is never made until something like arrhythmia crops up and then, there is that "ah ha" moment.

From the book, Healing Nutrients Within by Eric Braverman, MD.... he has a list of foods high in tyramine and indicated they are known to cause migraine headaches and also should be avoided in people with hypertension. He notes "the actual tyrosine content in foods is not entirely predictable."

These are the foods on the list:
Aged cheese - but general rule, all cheeses except cottage cheese and cream cheese.
Bananas and any food product made with bananas
Beer and ales
Broad beans and pods (lima beans, Italian broad beans, lentils, snow peas)
Chocolate in any form
Cultured diary products (buttermilk,yogurt, sour cream)
Figs (canned)
Legumes
Livers
Monosodium glutamate or MSG (additive in Chinese food, soy sauce, hydrolyzed vegetable protein, some packaged and snack foods)
Nuts and any food product containing nuts
Pickled herring and salted, dry fish
Pineapple and any food product containing pineapple
Prunes
Raisins ad any food product containing raisins
Soy Sauce
Vanilla extracts and any food product containing vanilla
Wine (esp. Chianti) and any food product made from wine
Yeast extracts
(page 31)

Jackie

Ablation may be the answer as you are getting more prone with time and the triggers are increasing....you can second guess yourself as to the reasona....and it will get quite frustrating.

Jackie,

Thanks for taking the time to provide this information. I'll look for Dr. Braverman's book as well.

I found his list of tyramine foods interesting in that it is a bit more aggressive than other lists I've seen. Following are some of the discrepancies between his list and my personal experience.

• Bananas - I've found that I can eat a banana or two a day without triggering an episode. I am careful however to avoid over-ripe bananas because the lists I've seen show over-ripe or dried fruits as high in tyramine.
• Nuts - I eat a lot of almonds as snacks. Daily. And found them to not be a trigger.
• Legumes - I have seen broad beans or fava beans on several lists and have avoided them. But I have not had a problem with other legumes. I eat peanut butter almost every day and peanuts are a legume.

As to your comment on alcohol, the lists I've seen show draft beers and some red wines as high in tyramine. I've found that bottled beer and white wine does not trigger an episode for me and have kept away from red wine and draft beers.

Foods that have seemed to be very definite triggers for me include raisons, hard aged cheeses, avocados. Other foods that I am very careful to avoid since seeing them on lists of high tyramine foods include cured meats, smoked fish and fermented foods like soy or teriyaki sauce.

It's very likely that tyramine is not the only trigger for me. Either way there is still lots to learn, but I am happy that the number of episodes I experience has dropped off greatly since I've been watching tyramine foods. If the frequency goes up again I will try cutting out a bit more from my diet, including a number of the things on Dr. Braverman's list.

Thanks again for the info.

--Larry



Edited 1 time(s). Last edit at 06/27/2017 11:00PM by lpoleshuck.