British Journal of Addiction (1992) 87, 1195-1197
RESEARCH REPORT
Can carrots be addictive? An extraordinary form of drug dependence LUDEK CERNYi & KAREL CERNY^ ' Antialcoholic Department, Psychiatric Clinic, Apolinarska 4, Prague 2 Experimental Oncology, Narodnt 8, Prague 2, Czechoslovakia
Department of
Abstract The paper describes three cases of dependence on carotenoids with typical symptoms of irritability and nervousness accompanying their abstinence, with a long-term dependence, and an inability to simply discontinue. Three patients (a man and two women) all being smokers, evaluated this dependence as very similar to that on tobacco. The limitation offurther use had the same effect in both cases. The women evaluate the dependence as stronger than that on cigarettes, the man as somewhat weaker. The former patient—a woman—even relapsed, and recently found herself in danger of further relapse. This, however, she nipped in the bud. Laboratory enzyme examinations revealed a disorder in the enzymatic outfit affecting the autoimmunity and the neurovegetative system.
Introduction Cases of hypercarotenemia are encountered in the literature only sporadically. Case studies have described the physical changes due to malnutrition, demal changes, particularly in children but have left the psychological states of these cases unrecorded.''^•''"' Hughes & Wooten met with hypercarotenemia as early as 1919, reference is made to it in their work The Orange people.^ The subjects were two agricultural workers whose diet had consisted predominantly of carrots and tomatoes. Their skin was orange in colour. The study includes no description whatsoever of their psychological state. No reference is made to their further life history. In my psychiatric practice I have encountered three cases of hypercarotenemia, accompanied by typical symptoms of drug dependence.
Analysis I came across the first case of this kind as early as 1954 in the Prague psychiatric clinic where a 35-
year-old woman was hospitalised because of a neurotic disturbance and she was consuming approximately 1 kg of raw carrots daily. Her skin as well as the sclerae of her eyes were coloured dark orange. Carrots were most difficult to procure in winter but she had to get hold of them at any price. Their lack made her suffer from typical withdrawal symptoms with a marked nervousness state. After discharge from hospital, she was lost to follow-up. In 1985, a 38-year-old nurse attended for help. Patient A. L. was born in 1947 and worked as a nurse. She had commenced smoking at 18 years of age, stopped during pregnancy and at presentation she smoked 20 cigarettes daily. She consumed alcohol only occasionally and also occasionally drank 2-3 cups of coffee daily when at work, but only one cup when at home. She is married with one daughter. She started consuming carrots during her first pregnancy in 1970 when she suffered from cardialgie and excess acidity of stomach fluids, accompan-
1195
1196
Ludek Cemy & Karel Cemy
ied by hyperemesis. Being unable to tolerate fruits, she took to consuming vegetables in large quantities. In a fortnight she consumed a bed of young carrots. She soon found that she took pleasure in it, or so she said. She ate carrots in this manner and quantity throughout her pregnancy. After childbirth, she stopped eating carrots and returned to normal. She estimated that she had consumed two and a half sacks of carrots during her pregnancy. She noted that her skin became intensely yellow. Her stomach troubles accompanied by occasional vomiting recurred in 1985. She resumed eating carrots regularly and in the course of a single week, she ate 1 kg of carrots daily. Carrots had to be eaten raw. Cooked carrots failed to quench her craving. Her desire became so intense that she preserved the carrots peelings as a reserve supply. In the winter months and particularly in spring, when carrots lose much of their pleasant fiavour and become rather bitter, she added sugar to them. If she ran out of carrots at the weekend, she would ask a neighbour to give her some. When no carrots were available, she became desperately nervous. Sometimes she would bite off a mouthful of carrot even before washing it. In the morning she would feel a desire for carrots and would peel and eat them even on her way to work. Her acquaintances began to make fun of her and even to scold her. She then resorted to purchasing and eating carrots secretly. Another time, in the premises of the horse-racing course where she often comes in company with her daughter, large cases loaded with carrots were delivered to the stables. She had nothing with her to put the carrots in. Her craving for carrots was so intense that she went to borrow a plastic bag and took the carrots directly from the discharged cases. She had tried to reduce her carrot consumption several times but all her efforts have failed. Of late, due to poor market supply of carrots, she has attempted to cure herself of this habit. She is partly successful and crunches something else instead, e.g. radishes. At the same time she is considerably nervous. She has noticed a tendency to more copious bleeding but no other difficulties are involved. The patient is subjected to a continuous followup. During her last check-up she imparted the information that 2 years ago she got rid of her dependence on carrots—these she completely left out of her menu. About Christmas 1990, she tasted carrots several times when cooking, and again found them appealing to her palate. She realized that she might quickly become dependent on them again. When this was brought home to her, she managed to
stop taking carrots in time. At present she has no difficulties. Somatoneurological findings were within the norm. Her skin is orange in colour, especially the undersurfaces of her feet and her palms. A complex examination of the level of retinol, carotenoids in general, and beta-carotene in the serum, as well as of some enzymatic systems including the determination of the enzymatic activity of the following parameters was carried out. The test battery applied here was recommended after a consultation with specialists in internal diseases about the possibilities of rendering certain biological changes. These tests cover the area of the description of liver, cardiac and neurovegetative diseases recommended by the German Medical Chamber for the purposes of clinical diagnostics. In compliance with the results of enzymatic tests, metabolic disorders in the enzymatic pattern can be distinguished in great detail, and the patient's metabolic condition as well as his disease can be monitored by methods non-aggressive in long-term application. Our material shows a marked impairment of the patient's enzymes. A particularly marked intesification of activity has been found in aldolase (ALD) as well as cerebral creatinkinase (CK B) and lipase. Lower values in comparison with the norm were found in arylesterase (AE), alkaline phosphomonoesterase (AP), and cholinesterase (CHS). Her high carrot intake resulted in substantially higher values of retinol, beta-carotene and carotenoids in general. A predominant representation of lycopens and plant carotenoids were found in the serum. In evaluating the profile of the patient's enzymes, it may be stated that the patient's dependence on carrots led to a metabolic imbalance. After a longterm monitoring of the patient's condition, the detected changes were found to depend on the quantity of consumed carrots, and, after a relatively long abstinence, they return to normal. In all probability, the changes involved are not persistent. Our third case was a 40-year-old man, J. T. who was undergoing treatment for multiple sclerosis. In spring 1988, he turned up at an anti-smoking advice centre in Prague asking for help to stop smoking. He had made numerous unsuccessful attempts to stop himself because of his concerns for his general health. His wife had advised that it was necessary to replace cigarettes with something else and recommended a substitute—fruit, or crunching some vegetables. She gave him carrots and he found that it helped him to forget about cigarettes. He was soon eating carrots constantly, consuming up to five
Can carrots be addictive?
1197
bunches a day, and as it was spring he put himself to difficulties caused by a lack of carrots were far more considerable expense. His craving for carrots be- intensive than those called forth by a lack of came as urgent as his previous craving for cigarettes. cigarettes. The quality of difficulties is the same as Whenever the image of carrots entered his mind, or in the case of smoking. The patient J. T. mentioned whenever he happened to catch sight of them, he the same difficulties as the above patient but immediately imagined himself eating them and evaluated their intensity as somewhat lesser than in started yearning for them. The consumption of smoking. This patient, however, had not been carrots stopped his urge for something, and again he consuming carrots for such a long time as the patient helped himself to carrots. If a sufficient amount of A. L. The ascertainment that raw carrots have the carrots were available, he would crunch them in same effects as drugs of the nicotine type set me rapid succession—this perfectly supplanted the thinking what substance in carrots might be incigarettes and, in the same way, it was fixed in his volved. The first to come into consideration was the consciousness. He ate the carrots at home but also biologically active carotene. could not resist eating them in public. When he went For the time being, however, I cannot discount shopping, he felt compelled to eat the carrots he had the possibility that carrots may contain another already bought on his way home on the train. active substance conducive to drug addiction. In this The anti-smoking advice centre advised him area, experimentation seems necessary. This is why against such habitual carrot consumption. He imme- the aim of this communication is to draw the diately started doing his level best to give up carrots. competent specialist's attention to this odd quality Although the habit was not as strong as the of carrots. A higher carrot intake resulted in a dependence on cigarettes, it took him a long time to metabolic disorder particularly in the area of the suppress it completely. He went on buying carrots auto-immunity system, the neurovegetative system throughout the summer—he was, however, con- and the central nervous system, as is the case in scious of the necessity to be on his guard. It was only neuroses. The condition improved after giving up in autumn when carrots became rare in the market the consumption of carrots. Also the recurring that he stopped eating them. In spring 1989 he did relapse in patient A. L. was interesting—it was not feel compelled to indulge in eating carrots any similar to that found with other drug types. more, though he continues to like them even now. After his visits to the advice centre he successfully stopped smoking and abstained from it for 4 References months. However, he relapsed after some stress 1, COHEN, L, B, (1985) Observation on carotenemia. Annuals of Internal Medicine, 48, pp, 219-227, situation at work.
Discussion The three cases of raw-carrot abuse described here are remarkable for giving rise to a psychic dependence, identical with drug addiction as defined by the WHO (1969), in all the three affected persons —two women and one man. The lack of carrots made them lapse into a state of heightened irritability, nervousness. The withdrawal syndrome is so intense that the affiicted persons get hold of and consume carrots even in socially quite unacceptable situations. In view of the fact that both the patients described in detail were also smokers, it was possible to discuss with them the intensity of the dependence. The patient A. L. stated that the psychic
2,
FiSHMAN, J, E, & JOSEPHS, A, Y, (1981) Benign carotenemia. Archives of Diseases in Childhood, 56, p, 965,
3,
HUGHES, J, D, & WOOTEN, R. L , (1966) The orange
4, 5, 6,
people. Journal of the American Medical Association, 197, pp, 730-731. KING, C , & MURANO, G , (1980) Mysterious dietary hypercarotenemia. Clinical Research, 28, p, 231, LASCARI, A. D , (1981) Carotenemia, Clinical Pediatrics, 20, p, 25, PATEL, H , , DUNN, H , G , , TISCHER, B , et al. (1973)
Carotenemia in mentally retarded children, Canadian Medical Association Journal, 108, pp, 848-852, 7,
SHOENFELD, Y , , SHAKLAI, M , , BEN-BAKUCH, N . ,
HiRSCHORN, M, & PiNKHAUS, J. (1982) Neutropenia induced by hypercarotenemia. Lancet, i, p. 1245, 8,
VAKIL, D , V,, AYiOMAMms, A, & NIZAMI, R, M ,
(1985) Hypercarotenemia, Nutritic Research, 5, pp, 911-917,
RESEARCH REPORT
Can carrots be addictive? An extraordinary form of drug dependence LUDEK CERNYi & KAREL CERNY^ ' Antialcoholic Department, Psychiatric Clinic, Apolinarska 4, Prague 2 Experimental Oncology, Narodnt 8, Prague 2, Czechoslovakia
Department of
Abstract The paper describes three cases of dependence on carotenoids with typical symptoms of irritability and nervousness accompanying their abstinence, with a long-term dependence, and an inability to simply discontinue. Three patients (a man and two women) all being smokers, evaluated this dependence as very similar to that on tobacco. The limitation offurther use had the same effect in both cases. The women evaluate the dependence as stronger than that on cigarettes, the man as somewhat weaker. The former patient—a woman—even relapsed, and recently found herself in danger of further relapse. This, however, she nipped in the bud. Laboratory enzyme examinations revealed a disorder in the enzymatic outfit affecting the autoimmunity and the neurovegetative system.
Introduction Cases of hypercarotenemia are encountered in the literature only sporadically. Case studies have described the physical changes due to malnutrition, demal changes, particularly in children but have left the psychological states of these cases unrecorded.''^•''"' Hughes & Wooten met with hypercarotenemia as early as 1919, reference is made to it in their work The Orange people.^ The subjects were two agricultural workers whose diet had consisted predominantly of carrots and tomatoes. Their skin was orange in colour. The study includes no description whatsoever of their psychological state. No reference is made to their further life history. In my psychiatric practice I have encountered three cases of hypercarotenemia, accompanied by typical symptoms of drug dependence.
Analysis I came across the first case of this kind as early as 1954 in the Prague psychiatric clinic where a 35-
year-old woman was hospitalised because of a neurotic disturbance and she was consuming approximately 1 kg of raw carrots daily. Her skin as well as the sclerae of her eyes were coloured dark orange. Carrots were most difficult to procure in winter but she had to get hold of them at any price. Their lack made her suffer from typical withdrawal symptoms with a marked nervousness state. After discharge from hospital, she was lost to follow-up. In 1985, a 38-year-old nurse attended for help. Patient A. L. was born in 1947 and worked as a nurse. She had commenced smoking at 18 years of age, stopped during pregnancy and at presentation she smoked 20 cigarettes daily. She consumed alcohol only occasionally and also occasionally drank 2-3 cups of coffee daily when at work, but only one cup when at home. She is married with one daughter. She started consuming carrots during her first pregnancy in 1970 when she suffered from cardialgie and excess acidity of stomach fluids, accompan-
1195
1196
Ludek Cemy & Karel Cemy
ied by hyperemesis. Being unable to tolerate fruits, she took to consuming vegetables in large quantities. In a fortnight she consumed a bed of young carrots. She soon found that she took pleasure in it, or so she said. She ate carrots in this manner and quantity throughout her pregnancy. After childbirth, she stopped eating carrots and returned to normal. She estimated that she had consumed two and a half sacks of carrots during her pregnancy. She noted that her skin became intensely yellow. Her stomach troubles accompanied by occasional vomiting recurred in 1985. She resumed eating carrots regularly and in the course of a single week, she ate 1 kg of carrots daily. Carrots had to be eaten raw. Cooked carrots failed to quench her craving. Her desire became so intense that she preserved the carrots peelings as a reserve supply. In the winter months and particularly in spring, when carrots lose much of their pleasant fiavour and become rather bitter, she added sugar to them. If she ran out of carrots at the weekend, she would ask a neighbour to give her some. When no carrots were available, she became desperately nervous. Sometimes she would bite off a mouthful of carrot even before washing it. In the morning she would feel a desire for carrots and would peel and eat them even on her way to work. Her acquaintances began to make fun of her and even to scold her. She then resorted to purchasing and eating carrots secretly. Another time, in the premises of the horse-racing course where she often comes in company with her daughter, large cases loaded with carrots were delivered to the stables. She had nothing with her to put the carrots in. Her craving for carrots was so intense that she went to borrow a plastic bag and took the carrots directly from the discharged cases. She had tried to reduce her carrot consumption several times but all her efforts have failed. Of late, due to poor market supply of carrots, she has attempted to cure herself of this habit. She is partly successful and crunches something else instead, e.g. radishes. At the same time she is considerably nervous. She has noticed a tendency to more copious bleeding but no other difficulties are involved. The patient is subjected to a continuous followup. During her last check-up she imparted the information that 2 years ago she got rid of her dependence on carrots—these she completely left out of her menu. About Christmas 1990, she tasted carrots several times when cooking, and again found them appealing to her palate. She realized that she might quickly become dependent on them again. When this was brought home to her, she managed to
stop taking carrots in time. At present she has no difficulties. Somatoneurological findings were within the norm. Her skin is orange in colour, especially the undersurfaces of her feet and her palms. A complex examination of the level of retinol, carotenoids in general, and beta-carotene in the serum, as well as of some enzymatic systems including the determination of the enzymatic activity of the following parameters was carried out. The test battery applied here was recommended after a consultation with specialists in internal diseases about the possibilities of rendering certain biological changes. These tests cover the area of the description of liver, cardiac and neurovegetative diseases recommended by the German Medical Chamber for the purposes of clinical diagnostics. In compliance with the results of enzymatic tests, metabolic disorders in the enzymatic pattern can be distinguished in great detail, and the patient's metabolic condition as well as his disease can be monitored by methods non-aggressive in long-term application. Our material shows a marked impairment of the patient's enzymes. A particularly marked intesification of activity has been found in aldolase (ALD) as well as cerebral creatinkinase (CK B) and lipase. Lower values in comparison with the norm were found in arylesterase (AE), alkaline phosphomonoesterase (AP), and cholinesterase (CHS). Her high carrot intake resulted in substantially higher values of retinol, beta-carotene and carotenoids in general. A predominant representation of lycopens and plant carotenoids were found in the serum. In evaluating the profile of the patient's enzymes, it may be stated that the patient's dependence on carrots led to a metabolic imbalance. After a longterm monitoring of the patient's condition, the detected changes were found to depend on the quantity of consumed carrots, and, after a relatively long abstinence, they return to normal. In all probability, the changes involved are not persistent. Our third case was a 40-year-old man, J. T. who was undergoing treatment for multiple sclerosis. In spring 1988, he turned up at an anti-smoking advice centre in Prague asking for help to stop smoking. He had made numerous unsuccessful attempts to stop himself because of his concerns for his general health. His wife had advised that it was necessary to replace cigarettes with something else and recommended a substitute—fruit, or crunching some vegetables. She gave him carrots and he found that it helped him to forget about cigarettes. He was soon eating carrots constantly, consuming up to five
Can carrots be addictive?
1197
bunches a day, and as it was spring he put himself to difficulties caused by a lack of carrots were far more considerable expense. His craving for carrots be- intensive than those called forth by a lack of came as urgent as his previous craving for cigarettes. cigarettes. The quality of difficulties is the same as Whenever the image of carrots entered his mind, or in the case of smoking. The patient J. T. mentioned whenever he happened to catch sight of them, he the same difficulties as the above patient but immediately imagined himself eating them and evaluated their intensity as somewhat lesser than in started yearning for them. The consumption of smoking. This patient, however, had not been carrots stopped his urge for something, and again he consuming carrots for such a long time as the patient helped himself to carrots. If a sufficient amount of A. L. The ascertainment that raw carrots have the carrots were available, he would crunch them in same effects as drugs of the nicotine type set me rapid succession—this perfectly supplanted the thinking what substance in carrots might be incigarettes and, in the same way, it was fixed in his volved. The first to come into consideration was the consciousness. He ate the carrots at home but also biologically active carotene. could not resist eating them in public. When he went For the time being, however, I cannot discount shopping, he felt compelled to eat the carrots he had the possibility that carrots may contain another already bought on his way home on the train. active substance conducive to drug addiction. In this The anti-smoking advice centre advised him area, experimentation seems necessary. This is why against such habitual carrot consumption. He imme- the aim of this communication is to draw the diately started doing his level best to give up carrots. competent specialist's attention to this odd quality Although the habit was not as strong as the of carrots. A higher carrot intake resulted in a dependence on cigarettes, it took him a long time to metabolic disorder particularly in the area of the suppress it completely. He went on buying carrots auto-immunity system, the neurovegetative system throughout the summer—he was, however, con- and the central nervous system, as is the case in scious of the necessity to be on his guard. It was only neuroses. The condition improved after giving up in autumn when carrots became rare in the market the consumption of carrots. Also the recurring that he stopped eating them. In spring 1989 he did relapse in patient A. L. was interesting—it was not feel compelled to indulge in eating carrots any similar to that found with other drug types. more, though he continues to like them even now. After his visits to the advice centre he successfully stopped smoking and abstained from it for 4 References months. However, he relapsed after some stress 1, COHEN, L, B, (1985) Observation on carotenemia. Annuals of Internal Medicine, 48, pp, 219-227, situation at work.
Discussion The three cases of raw-carrot abuse described here are remarkable for giving rise to a psychic dependence, identical with drug addiction as defined by the WHO (1969), in all the three affected persons —two women and one man. The lack of carrots made them lapse into a state of heightened irritability, nervousness. The withdrawal syndrome is so intense that the affiicted persons get hold of and consume carrots even in socially quite unacceptable situations. In view of the fact that both the patients described in detail were also smokers, it was possible to discuss with them the intensity of the dependence. The patient A. L. stated that the psychic
2,
FiSHMAN, J, E, & JOSEPHS, A, Y, (1981) Benign carotenemia. Archives of Diseases in Childhood, 56, p, 965,
3,
HUGHES, J, D, & WOOTEN, R. L , (1966) The orange
4, 5, 6,
people. Journal of the American Medical Association, 197, pp, 730-731. KING, C , & MURANO, G , (1980) Mysterious dietary hypercarotenemia. Clinical Research, 28, p, 231, LASCARI, A. D , (1981) Carotenemia, Clinical Pediatrics, 20, p, 25, PATEL, H , , DUNN, H , G , , TISCHER, B , et al. (1973)
Carotenemia in mentally retarded children, Canadian Medical Association Journal, 108, pp, 848-852, 7,
SHOENFELD, Y , , SHAKLAI, M , , BEN-BAKUCH, N . ,
HiRSCHORN, M, & PiNKHAUS, J. (1982) Neutropenia induced by hypercarotenemia. Lancet, i, p. 1245, 8,
VAKIL, D , V,, AYiOMAMms, A, & NIZAMI, R, M ,
(1985) Hypercarotenemia, Nutritic Research, 5, pp, 911-917,
