bookofjoe

BehindTheMedspeak: Pine Mouth Syndrome

In toxicology circles they call it cacogeusia, "a bad taste due to a bad-tasting substance."

Dysgeusia is a more frequently used term.

"Metallogeusia," the medical term for a bitter metal taste in the mouth, is a subtype of cacogeusia/dysgeusia.

It is important to understand the language before taking the plunge.

I knew you'd agree.

But I digress.

Elizabeth Weise's USA Today story introduced my unknowing self to this rare syndrome, which appears in some people a day or two after eating pine nuts (pictured up top), hence the vernacular "pine mouth syndrome."

The article follows.

Link Between Nuts, 'Pine Mouth Syndrome' Is Hard To Crack

Americans are expanding their repertoire of foods but confronting new medical problems along with it.

Pine mouth syndrome is a bitter, metallic taste in the mouth that can develop a day or two after eating pine nuts, a popular ingredient in pesto, salads, and Italian dishes.

First described by a Belgian poison-control doctor in 2001, the rare syndrome can linger for up to two weeks. An article about it in the Journal of Medical Toxicology found dozens of anecdotal reports online.

Marc-David Munk, a professor in the Department of Emergency Medicine at the University of New Mexico in Albuquerque, was struck with the syndrome himself and described it in the Toxicology paper.

"It's surprising to me that more people don't know about it," he said.

Although almost non-existent in the medical literature, the syndrome is certainly something people who have had it are aware of. In one year the Food and Drug Administration received 51 complaints of "taste disturbances" related to pine nuts. The agency hopes information from consumers and tests of pine nuts associated with this syndrome will help it determine what's causing the problem, says spokesman Michael Herndon. Because it's related only to taste, it's not considered a public health problem, he said.

It's known that pine nut oils become rancid very easily, so it's possible that as they degrade, they might form new molecules that somehow interact with the taste receptors, Munk said.

He experienced it firsthand at a buffet table at a restaurant where there was a bowl of pine nuts by the salad bar. "I just grabbed a handful of them and ate them raw. Within a couple of days, I developed metallogeusia" (meh-tal-ah-GOO-zee-ah)."

That's the medical term for a bitter metal taste in the mouth. Munk found it was even stronger when he drank red wine. His case lasted 10 days.

Though there's no scientific proof that the metallogeusia is linked to pine nuts, dozens of reports online suggest it is. Whether they're raw or cooked doesn't seem to matter.

Munk believes something in the pine nuts affects the signaling between the taste buds and the brain. There are several well-known triggers for metallogeusia, including ingesting certain seafood toxins, zinc deficiency, strokes and, most commonly, taking ACE inhibitors for blood pressure, he says.

In the Belgian case, the doctor was able to reproduce the symptoms by feeding the implicated pine nuts to two other people.

Americans consume over 10.4 million pounds of pine nuts each year. The overwhelming majority of pine nuts consumed in the United States come from China, according to the Department of Agriculture's Economic Research Service. According to the medical literature, a tiny proportion also come from Italy and Pakistan.

Costco, which because it is a membership organization can track exactly where a given batch of pine nuts came from, says it has had "two or three" reports of pine mouth from customers, spokesman Craig Wilson says.

The company took samples from the offending pine nuts and sent them and a control bag of pine nuts that didn't cause the symptoms off to nationally recognized labs.

"They were the same," Wilson said. "It's very strange." A full toxicological panel of tests revealed no differences.

"There are a lot of questions to be answered on this one," Munk says. But since his paper was published, he says, it has become clear that the condition is a real medical effect.

Below, the abstract of Dr. Munk's Toxicology paper.

'Pine Mouth Syndrome: Cacogeusia Following Ingestion of Pine Nuts (Genus: Pinus). An Emerging Problem?

We report a case of cacogeusia, specifically metallogeusia (a perceived metallic or bitter taste) following pine nut ingestion. A 36-year-old male presented with cacogeusia one day following ingestion of 10–15 roasted pine nuts (genus: Pinus). Symptoms became worst on post-exposure day 2 and progressively improved without treatment over 5 days. There were no other symptoms and physical examination was unrevealing. All symptoms resolved without sequelae. We contemporaneously report a rise in pine nut-associated cacogeusia reported online during the first quarter of 2009, and a significant rise in online searches related to pine nut-associated cacogeusia (or what the online public has termed "pine mouth") during this time. Most online contributors note a similar cacogeusia 1-3 days following pine nut ingestion lasting for up to 2 weeks. All cases seem self-limited. Patients occasionally describe abdominal cramping and nausea after eating the nuts. Raw, cooked, and processed nuts (in pesto, for example) are implicated. While there appears to be an association between pine nut ingestion and cacogeusia, little is known about this condition, nor can any specific mechanism of specific cause be identified. It is not known if a specific species of pine nut can be implicated. "Pine mouth" appears to be an emerging problem.

Never had pine nuts?

Well, then, how the heck do you know if you have pine mouth syndrome or not?

Only one way to find out.

An 2 oz. bag costs $3.99.

I ask you: Where else can you learn all about a rare syndrome, then be given the means right then and there to buy its trigger — all legal and above board —  to run a self-diagnostic test?

If paper towels could talk

What artist 

Marc Johns

does in

public restrooms.

SMOKE Incense Diffuser

From websites:

The SMOKE incense holder is made of handblown borosilicate glass.

The shape of its design — light and soft — seems to be defined by the swirls of smoke that slowly rise.

Hollow inside, the flowing organic form has a softly curved center and open ends.

A green glass drop marks the location of the holder in which is placed a stick of insense.

The small internal void that characterizes it was designed to hold an incense stick.

Extreme transparency creates an ethereal aura.

Minimal variations in shape, size, and color are to be considered an exclusive feature, a sign of quality and non-serial production.

Features and Details:

• 9.84" x 3.15" x 1.96"

• Handblown borosilicate glass

• Made in Venice, Italy

$48.10.