Do You Really Have to Avoid Cheese Before Ayahuasca?

Every ayahuasca diet list tells you to avoid aged cheese. Almost none of them tell you why, and the ones that do usually get the pharmacology a generation out of date. Here is the actual state of the evidence — and why the practical advice does not change even though the fear should.

Where the fear comes from

The classic MAOI antidepressants of the 1960s, like phenelzine, require a genuinely strict diet: no aged cheeses, no cured meats, no fermented foods. The reason is that they irreversibly block the enzyme that breaks down tyramine, an amine found in aged and fermented foods. Accumulated tyramine can then trigger a hypertensive crisisMAPS 1995

That is where the entire list of ayahuasca prohibitions you find online originally comes from. It was inherited wholesale from pharmaceutical MAOIs, and then repeated.

The nuance almost nobody passes on

Ayahuasca's alkaloids — harmine, harmaline — are not irreversible MAOIs. They are reversible inhibitors of MAO-A, known as RIMAsSystematic review 2020

The evidence is clear on the consequence: the risk of a tyramine interaction is lower with reversible MAO-A inhibitors than with irreversible onesSystematic review 2020 And the systematic review of ayahuasca interactions documents no human cases of a tyramine-induced hypertensive crisis with ayahuasca. It presents this as a theoretical risk derived from the pharmacology, not as something observed in practiceSystematic review 2020

So why follow it anyway? Four honest reasons

1. The risk is lower, not zero. Reversible does not mean harmless; at high doses, RIMAs can still cause problemsSystematic review 2020 "Unlikely" is not "impossible," and a hypertensive crisis is serious.
2. The cost asymmetry. Skipping cheese and cured meats for a few days costs you almost nothing. Getting it wrong costs a great deal. When the cost of caution is low and the cost of error is high, you are prudent. Always.
3. Your center will require it anyway. Serious protocols keep the restriction out of caution, and you are going to follow your center's protocol regardless.
4. It overlaps with the traditional dieta. Many tyramine-rich foods — cured meats, fermented foods, alcohol — are already excluded on other grounds. You are cutting them out either way.

The list itself

Foods to avoid in the days close to the ceremonyMAPS 1995:

• Aged and cured cheeses
• Cured or smoked meats and sausages — salami, chorizo, aged ham
• Smoked or cured fish
• Fermented foods — sauerkraut, soy sauce, miso
• Yeast extracts
• Fava beans
• Very ripe avocado, very ripe banana
• Red wine (chianti, sherry, vermouth) and beer — also excluded on other grounds
• Chocolate in excess
• Protein supplements and meat extracts

The part that actually deserves your fear

If you are going to be anxious about one thing in your preparation, be anxious about the correct one. The tyramine risk with ayahuasca is theoretical and undocumented in humans. The drug interaction risk is neither: serotonergic antidepressants combined with ayahuasca's MAOI effect is the interaction with a documented case of serious harm behind itSystematic review 2020

Skipping the cheese is easy and sensible. Reviewing your medications with a doctor is the part that matters.