A Problem Larger Than is Officially Reported
One simply has to look on the Internet to have a sense of how badly many people are being affected by PNS. I believe that the reason why the problem has not received the due amount of attention it deserves is because of the low frequency of official reports. It’s all about the numbers isn’t it? How many people report to authorities about being affected by these pine nuts? What fraction of the buyers of the pine nuts actually lodge a complaint? How many science publications have proved an adverse effect of these pine nuts?“I contacted the distributor and visited the store (Trader Joe’s) and asked that this lot be removed. But was told not everybody got pine mouth so they would not.” (Victim Account)
“…researchers have not found any safety issues…and it seems to affect a relatively small number of people…” (Whole Foods, USA)
Just how much does it take in order for control measures to be implemented and for products to be recalled?
The results from the current studies have shown that the proportions of people susceptible to PNS is a lot higher than that reflected by the reported frequencies of PNS. The controlled testing of 21 subjects (of 11 different nationalities) elicited noticeable PNS symptoms in 19 subjects with either 1g (11 subjects) or 10g (8 subjects) of P. armandii pine nuts administered. The survey findings have shown that people of all walks of life can be susceptible to PNS and susceptibility is definitely not an uncommon phenomenon. Given the right conditions and awareness of the problem, symptoms can be elicited in a majority of the population although individual sensitivity towards the adverse effects vary greatly.
The true incidence rates of PNS are grossly underestimated due to difficulties in diagnosing the problem, and the motivational factors in taking the trouble to report it to the retailers and food authorities. The following scheme illustrates the factors contributing towards the low reporting frequencies.
Individuals susceptible to PNS: as addressed in the research findings, many people are susceptible to PNS with varying extents, but a small number of people have been shown to be immune to the effects of the pine nuts even with large amounts consumed.
Symptomatic cases: pine nuts are an expensive gourmet product that are normally consumed in small quantities (e.g. sprinklings on salads, topped on confectionery). Many supermarket samples are furthermore mixtures of P. armandii with other non-PNS-causing species. Many susceptible individuals could have consumed problem samples without being afflicted with symptoms.
Diagnosed cases: the huge difficulty lies in associating the taste disturbance with pine nuts and it is believed that only a small fraction of symptomatic cases are actually diagnosed (many people only realize it much later and with repeated afflictions). Some reasons of this are as follows — (a) pine nuts taste fine at ingestion (b) symptoms appear 1-3 days later (c) symptoms can occur with a small quantity of pine nuts (d) victims have previously eaten pine nuts with no allergies (e) victims have eaten from the same brand of pine nuts with no allergies (f) short duration and mild cases could have been ignored without a search for a diagnosis (g) lack of information about PNS / access to information about it. Some victim accounts have been listed below to illustrate the difficulties experienced in diagnosing the syndrome.
Motivated cases: individuals have displayed greatly varying sensitivities towards the adverse effects of PNS. Milder cases would be less motivated to take action (filling in surveys or reporting to authorities and retailers).
Reported cases: few people actually are willing to spend the effort to take the issue to the authorities and to their local retailers. Some have reported that they were turned away by their local retailers for ‘never having heard of such a problem’.
It is unjustified to judge the magnitude of the problem based on the number of official reports due to lack of awareness of PNS and many obstacles that prevent consumers from being able to link their affliction to pine nuts. The fact that many people can be affected by it if given the right conditions, and the fact that some people could suffer long-lasting adverse effects from it (see page: adverse health effects) is strong reason to pay heed to this problem.
Victim Accounts on the Difficulties of Diagnosis:“…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.” “…The first time I had the weird taste sensation I did not make the connection to pine nuts. But when the second occurrence happened, I Googled ‘bad taste in mouth when and after eating” and saw the link to pine nuts. I think that so many people out there have not made the connection because it happens a few days afterwards and the nuts taste fine when eating them.” “I vaguely remember having a similar experience before when I was younger (approx 5-7 years ago) but didn’t realise it was due to pine nuts….The taste disturbance was definitely noticeable and annoying in the sense that foods tasted differently than they used to, but it wasn’t unbearable. It was very shocking to suddenly taste something as spicy hot. I was worried the change was here to stay, but thankfully it was fine.” “…This is the second time I’ve had this mouth bitterness issue – the first time I even went to the dentist to see if there was something ‘dentally’ wrong. The symptom lasted about two weeks, and coffee in particular tasted disgustingly bitter. This time I googled and found this site… Ah ha!!” “Symptoms pretty bad for about 14 days. After that, they lingered in lesser form for some time… Was treated like a lunatic by pharmacy and by doctor.” “I ate the pesto sauce on 2 occasions and the funny taste persisted over about a week and a half of time. Only problem is, I didn’t attribute it to the pesto until much later. I thought it was a new toothpaste I was using, then I switched to 2 more kinds of toothpastes before I concluded that it was not the toothpaste.” “… Got a big bag of pine nuts from Costco (which I hadn’t eaten previously for a long time). Unfortunately just started to use topical metronidazole for rosacea the same week I first ate the pine nuts…at first thought it was the metronidazole which can have a metallic after taste…immediately stopped using metronidazole. Continued to eat pine nuts over the course of the next week and bad taste continued, then discovered “pine mouth” while searching online and put the pieces together.” “…I have no idea where the pine nuts in the hummus spread came from or what type they are. I had consumed almost the whole 16 oz. container when I learned what was causing my problem. I have consumed the product before many times without a problem. Until I read about pine nut mouth, this experience was so alarming I thought I might have a brain tumor or some other medical condition, and was ready to call my physician, a very rare occurrence for me, when I googled “bitter soapy taste tongue” and read about the pine nut mouth. About 2 weeks later, it had completely resolved.”
[Updated: 5 June 2011]