Despite little known and researched about the health effects of the syndrome, food authorities and retailers are hastily dismissing the pine nut syndrome (PNS) as a non-food safety issue due to the low frequency of reports and due to most cases resolving on their own without medical intervention.“This is not a food safety issue, but the Agency is trying to get more information about why this is happening… As far as the Agency is aware, no adverse health effects have been associated with these symptoms.” (Food Standards Agency, UK)
It is also a common misconception that the taste senses are only a tool of pleasure, neglecting that severe and extended taste disturbances affects the quality of life by preventing the proper ingestion of food and nutrient intake. The symptoms of PNS also caused psychological and physical distress when victims are not able to establish what the problem is and are subjected to medical treatments. Moreover, taste disturbances as well as other physical manifestations such as diarrhea, stomach pains, nausea and headaches, are often signal underlying negative physiological effects. A small number of cases also reported long-lasting and recurring taste disturbances from a few months to 2 years after an extended period of PNS.
Due to each individual case involving different amounts of pine nuts, individual sensitivities, number of ingestion events, period of ingestions, and other possible interacting factors like age, sex, gender, diet, physiological health, it is necessary to also consider individual cases (statistics don’t provide an accurate picture) as an indicator of the potential adverse effects of the problem pine nuts on consumers.
Below, I have included several victim cases to illustrate the above-mentioned points on why PNS should be considered a health issue.
(a) Restricts eating behaviors and prevents the proper ingestion of food
In many severe cases, victims are unable to obtain proper nutrition during the course of symptoms, which could last for weeks and months if the pine nuts are repeatedly ingested without the victim’s knowledge of the cause of the problem. Not only is the pleasure of eating lost, victim’s health is compromised and weight loss is frequently reported.“…I’m on day 2 and the bitterness is so intense that the inside of my mouth feels blistered and sore. I usually only drink water and tea but water tastes absolutely foul right now and while tea is OK at the time, the bitter aftertaste is disgusting. I drank a glass of water with a pinch of bicarbonate of soda this morning – that was better than plain water. But I’ve since tried peppermint tea and that is definitely good. I’ve also discovered that I can eat crystallized ginger and salted peanuts, so that’s what I’m going to be living on for the next few days.” “I ate only crackers and water for days to get me through it, it was terrible!” “…its Wed today. I live in country NSW Australia & I ate pine nuts last fri night in couscous & again on Sat night in dip. Bad taste started on Sat but Sunday it progressed across everything I ate. … I have got progressively worse and today it is very bad. Last night was very nauseated and today so bad I have taken 1/2 an imodium tab to see if that works. I still eat and drink in an attempt to override it but some foods are overwhelmingly disgusting, eg feta cheese & carrots. Peppermint tea does subside it a bit. i have had a few sporadic headaches that go away with panadol. Luckily I can take time out as I really don’t want to do anything until this thing passes…my stomach is very bloated and noisy with gastro type pain and intermittent nausea, and sometimes I almost feel disorientated when the metallic mouth surges.” “I have tried to eat a variety of the foods that are mentioned as ok, but found for me that only vinegar and lemon are ok. I put this on a bunch of spinach last night so I could eat something. This was still tough. Green olives were tolerable. Water is good. Sour apple chewing gum is what I go to after trying something and hating it, to get that bitter out as fast as possible. For me, the spicy foods do not work; hummus, dark stout beer, cheese, ice cream, cupcake, very sweet cookie, muffin, salty chips, were all bad. Peanut butter was tolerable, and peppermint tea is great. I have decided to take this opportunity to start the Master Cleanse diet today–it’s a liquid cleanse with ingredients of fresh lemon and grade B maple syrup. I’ve done the cleanse before and liked it. Since I can’t eat, this seems like a good time to do it and the drink is ok (lemons are the best relief I have found).”
(b) Psychological distress from repeated and extended afflictions
The lack of awareness of the problem and the difficulties in associating the symptoms with pine nuts ingested 1-3 days ago have caused many people to consume the problem pine nuts on multiple occasions or over an extended period of time. Not knowing what was the root of the problem has caused a lot of distress, especially with doctor visits that warned of more severe health disorders.“…This happened to me in 2004 but I didn’t relate the problem to pine nuts. I still am not sure it was that back then, but it lasted 3 months. I went to every medical specialist, had all kinds of tests and nothing turned up. Then it just went away. Now that I look back, I remember just one time ever purchasing a very large bag of pine nuts at Costco because they were a good price for a very large amount. I am thinking now, that I must have munched on them for a period of three months and when they ran out, that was when the symptoms disappeared. This is the weirdest thing I ever heard. Last time I had an MRI of my brain, and an endoscopy. It was very frightening. I had no other symptoms beside taste disturbance.” “…I first had pine nut syndrome in May of 2009, from Trader Joe’s toasted pine nuts (Korea/Russia origin), and it was very hard to find information about it then – I was so worried until I finally found something about it and it clicked. I kept eating pine nuts, because I love them, and haven’t had any issues for almost 2 years, even eating the SAME pine nuts from Trader Joe’s. Now I have it again, and I recognized that bad taste in my mouth instantly! I had pine nuts on my pasta (plus a handful plain) and 12 days later (2 days if it was after the first time, 1 day if it was the leftovers that did it!), I’ve got it again. THIS time, however, there are many resources available, the best of which is your blog!! It is also not as bad this time – I don’t know if it is actually less severe, or if knowing what it is and that it will pass makes it easier, or if it’s just that I know which foods to avoid.” “…I had been experiencing this off and on for several months before relating it to the pine nuts I had been eating…. I have eaten pine nuts many times in the past with no ill effects but never this size or shape of pine nut raw before (small and roundish instead of longer and more oblong.) I can dimly recall other incidents of bad taste over the last few years which may have occurred after eating pine nuts or pesto, but back then I did not relate my symptoms to something I had been eating. This definitely makes me want to avoid pine nuts in the future, which makes me very sad as I think they are delicious.”
(c) Unwarranted medical treatments from wrong diagnoses
The recentness of the problem and the lack of published information about it means that the syndrome is largely unknown by medical doctors, who then subsequently prescribe drugs believing that the taste disturbances are due to other health disorders.“My dentist put me on antibiotics for a week thinking it maybe an infected root canal. This straggly did improve the symptoms but they came back when the course finished and I had another salad.” “…I saw a couple of doctors when I first experienced the bitter taste in my mouth they were not aware of the pine nut syndrome then. That was in mid July, and I was prescribed one tablet of Nexium 40mg daily (manufactured by AstraZeneca UK Limited) for a couple of weeks, for what was presumed to be some mild incidence of reflux disease. The medicine seemed to have cured the problem (unless in reality it was the symptom itself which had worked its way out of my system), but soon enough it recurred a couple of times which is when I found about the pine nut syndrome in the course of an internet search, having googled “bitter taste in the mouth”.
(d) Long-lasting effects of taste disturbance
There were several cases that reported long-lasting taste disturbances, especially after an extended period of ingesting a large problem batch of pine nuts. No consumer should be subjected to such a possibility of long-term adverse effects.“It is about two years ago…over a long time we ate a lot of pine nuts in dishes, as a snack and so on. I still have complaints (especially bread and wine still taste bitter and like metal)…” “I got pinemouth in mid january of this year and I still have it! that means I have had it for 4.5 months!!!!! the severity has dropped it plataued after 6 weeks but is not getting any better…..” “… I am doing better at the 3 weeks mark. My symptoms are 90% improved. IT has been awful and I hope that one day there will be a warning about eating raw pine nuts. … sometimes I have a good day and then it returns. 3 months later: …I am still having some weird taste issues, not knowing why.”
[Updated: 5 June 2011]