Monoamine Oxidase Inhitors (MAOI), a class of antidepressant drugs, can interact with tyramine containing foods such as fermented foods (aged cheese, soy sauce, etc), spoiled/pickled/aged meats, chocolate, fava beans, yeast, bananas, avocados, pineapple, figs, etc. A hypertensive reaction occurs, which can then result in a stroke.
It is assumed that inhibition of especially MAO-A prevents the breakdown of tyramine. An excess amount of tyramine displaces norepinephrine in the storage vesicles. The excess norepinephrine causes hypertension.
Safe levels of tyramine stated as <6 mg to prevent interaction (according to a research study). A few research studies suggest that chocolate is an unnecessary restriction. Two sources say that there is approximately 0.003 mg tyramine per 1g cocoa. If a New Direction consumer were to eat four servings of Chocolate Pudding, the product with the highest cocoa content, they would consume 0.12mg. This is under the safe use level suggested. However, warnings on all medication labels and from pharmacists still suggest to avoid cocoa and chocolate.
Archer Daniels Midland Company (ADM), one of the largest cocoa suppliers, does not have the tyramine level for their cocoa. However, they have confirmed that it may contain Tyramine.