Dairy and tyramine: 49 foods rated

Blue cheeses are among the highest here because the mould is grown THROUGH the paste rather than on its surface - protein breakdown happens everywhere at once. A small portion is still a large dose, which is why MAOI guidance names them alongside aged cheddar.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Brie ripens from the rind inwards, and the tyramine follows that front - the chalky centre of a young brie and the runny edge of an over-ripe one are not the same dose. This is the rare case where you can judge the level by looking at it.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Camembert is smaller than brie and ripens faster for it - the same mould with less distance to travel - so it reaches the runny stage in weeks. The ammonia smell of a ripe one is protein breakdown announcing itself, and that is the same process that makes the tyramine.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Cheddar is the cheese the 'cheese effect' was named after - the first MAOI hypertensive reactions in the 1960s were traced to it. Bacteria break the milk protein down over months and decarboxylate its tyrosine. The measured spread is enormous and that is the practical point: mild and processed cheddar average under 150 mg/kg, extra-sharp around 270, and the highest single sample on record reached 700 - you cannot tell which piece you have. For someone on a non-selective MAOI the dose commonly cited as dangerous is about 6 mg, which an extra-sharp cheddar delivers in roughly 25 g.

• Sadighara P et al., Food Production, Processing and Nutrition 6:30 (2024), systematic review of tyramine in cheese
• Gardner et al., J Clin Psychiatry 1996
• Shulman KI et al., J Clin Psychopharmacol 9 (1989)

Emmental is ripened warm for weeks so that propionibacteria can make the holes, and warm plus weeks is the condition that builds amines fastest. It tastes mild, which is exactly why it catches people out - flavour does not track tyramine.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Feta ripens in brine rather than in air, and salt selects for salt-tolerant bacteria while slowing the rest - so it builds tyramine more slowly than a rind-ripened cheese of the same age. Two to three months is the usual cure, at the short end of this group.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Gorgonzola comes in two versions, and they are not the same food for tyramine: the DOP sets fifty days of ripening at the least for DOLCE, which stays soft and spreadable, and eighty for PICCANTE, which is firm and sharp. Choosing the sweet one is a real lever, and it is printed on the wrapper.

• AOP and DOP specifications of the cheeses named, for the minimum ageing
• EFSA Panel on Biological Hazards, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006

Gouda spans the widest tyramine range of any cheese here: a young gouda is four weeks old, a belegen six months, and an overjarige - the oldest grade sold - three years. They are sold under the same name, and the difference between them on this axis is larger than the difference between two different cheeses. Read the grade, not the name.

• AOP and DOP specifications of the cheeses named, for the minimum ageing
• EFSA Panel on Biological Hazards, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006

Gruyere is aged five to eighteen months with its rind washed throughout, and washing feeds the surface bacteria that break protein down into tyramine. The age on the label is the number that matters: a cave-aged wheel sits well above a young one.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

'Hard cheese' on an ingredient list is a category, not a cheese, and it is used precisely when the maker will not name one. Assume the long-aged end: cheese bought in bulk for a sauce or a ready meal is bought for flavour, and flavour means age, and age means tyramine.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Parmigiano Reggiano is aged 12 months at the least and commonly 24 or 36, and tyramine tracks ageing closely - which puts a well-aged wheel at the top of this axis with mature cheddar. The specification forbids additives, selected cultures and silage feed entirely, so nothing interrupts the bacteria: the ageing is the whole story. The white crystals in an old piece are tyrosine, the amino acid they turn into tyramine.

• Parmigiano Reggiano and Grana Padano DOP specifications, for the minimum ageing and the lysozyme provision
• EFSA Panel on Biological Hazards, EFSA Journal 2011, and McCabe-Sellers et al., J Food Compos Anal 2006, for the amines

Raclette is aged three to six months, which would place it mid-range - but it is eaten melted, by the scraping, in quantities nobody would eat cold. On an axis where the tyramine dose decides whether a reaction is discomfort or a crisis, the portion is the whole point.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Roquefort stacks three things that each raise tyramine: sheep's milk, richer in protein than cow's; Penicillium grown right through the paste rather than on the rind; and the ageing its AOP requires - at least fourteen days in the Combalou caves and three months in all before it may be sold, usually more. It is habitually cited among the highest cheeses measured.

• AOP and DOP specifications of the cheeses named, for the minimum ageing
• EFSA Panel on Biological Hazards, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006

Sheep's-milk cheeses are made from a milk far richer in protein than cow's, and protein is the raw material here - more tyrosine to decarboxylate into tyramine. They are also usually aged long. Pecorino romano and manchego curado are the two most likely to be on a table.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Fontina is the other moderate tyramine here, and the reason is simply time: its DOP specification sets eighty days as the minimum ripening, against the twelve months parmigiano's specification requires. Same milk, same bacteria, under a quarter of the ageing - the clearest demonstration in this group that the cheese family tells you nothing and the ageing tells you everything.

• AOP and DOP specifications of the cheeses named, for the minimum ageing
• EFSA Panel on Biological Hazards, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006

Grana Padano is one of only two cheeses in this group that is not high, and its specification explains why better than its age does. Its minimum ageing is 9 months against parmigiano's 12 - a small gap - but it also permits LYSOZYME, up to 2.5 g per 100 kg, added precisely to stop unwanted fermentation. Parmigiano allows no additive at all. Suppressing bacteria is what suppresses tyramine.

• Parmigiano Reggiano and Grana Padano DOP specifications, for the minimum ageing and the lysozyme provision
• EFSA Panel on Biological Hazards, EFSA Journal 2011, and McCabe-Sellers et al., J Food Compos Anal 2006, for the amines

Kefir is a live culture of yeasts and bacteria still building tyramine when you drink it - and it keeps working in the fridge, so an old bottle is not the drink you bought. A short ferment and a small glass from a fresh batch is the form that behaves.

• EFSA Journal 2011 (tyramine and histamine in fermented foods)
• McCabe-Sellers et al., J Food Compos Anal 2006

Lactose-free cheese demonstrates that these two axes are unrelated: the lactose is removed by adding lactase, an enzyme that acts on sugar and does nothing to protein - and tyramine comes from protein. A lactose-free mature cheddar has exactly the tyramine of a mature cheddar.

• EFSA Panel on Biological Hazards, Scientific Opinion on tyramine and histamine in fermented foods, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006
• Gardner et al., J Clin Psychiatry 1996

Buffalo mozzarella is a fresh cheese eaten within days of making. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.

Buttermilk is a short soured culture, hours rather than months. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.

Crème fraîche is a brief culture stopped at thickening. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.

Goat cheese is fresh goat cheese, not the aged kind. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.

Grated mozzarella is a young, low-tyramine cheese turned into a high-surface product with a long shelf life - grating multiplies the exposed area and the pack then sits for weeks. Nobody has measured the bag against a block grated at home, so take that as reasoning rather than a figure: more surface and more time is the mechanism that governs amines everywhere else, and it is the only reason this sits above plain mozzarella.

• EFSA Panel on Biological Hazards, EFSA Journal 2011
• McCabe-Sellers et al., J Food Compos Anal 2006

Greek yogurt is strained yogurt, concentrated from a short culture. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.

Lactose-free yogurt is the same short culture with the sugar split. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.

Milk powder is dried milk, where nothing can grow. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.

Skimmed milk is milk itself, before any culture has worked on it. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.

Yogurt is a culture chosen for acidity, working overnight. On this axis dairy splits in two, and the dividing line is ripening: aged cheese is one of the four foods a MAOI diet excludes outright, while fresh dairy is among the safest things on the shelf. The same milk becomes either one.