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I I 1 I i I I I I I I I I 11 I I I 1 Bruuh journal of Addict:on (1992) 87, 1195-1197 RESEARCH REPORT Can carrots be addictive? An extraordinary form of drug dependence LUDEK CERNI71 & KAREL CERNI'= ' Antialcoholic Department, Psychiatric Clinic, Apolinarska 4, Prague 2 & t Depanment of Experimental Oncology, 1Varodnf 8, Prague 2, Czechoslovakia Abstract T7u paper describes three cases of dependence on carotenoids with typical symptoms of irritability and nervousness accompan)ntg their abstinence, with a long-term dependence, and an inabiliry to simply discontinue. Three patienu (a man and two women) all bcing smoken, evaluated this dependence as very stmilar to that on tobacco. 77u limitation of funker use had the same effect in both cases. The momen evaluate the dependence as serostger than that on cigaretus, the man as somewhat weaker. The former patieu-a woman-even relapsed, and recently found herself in danger of further relapse. This, home9er, she nipped in the bud. Laborarory enryme examinations revealed a disorder in the ertsymatic outfu affecting the auto- immunity and tlte neurovegetatifle sysum. 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 uare- corded.'~'-' Hughes & Wooten met with hypercar- otenemia as early as 1919, reference is made to it in their work The Orange people.3 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 hyperarotenentia, accompanied by typical symptoms of drug dependence. Analys" I cam across the fint case of this kind as early as 1954 in the Prague psychiamc 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 bei 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 cardial- gie and excess acidity of stomach fluids, accompan- 1195 I

I I I i I I I I I I I I I I I I 1196 Ludik Cmn, & Karel Cerny' ied by hyperemesis. Being unable to tolerate fruus, she took to consuming vegetables in large quanutres. 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 vottuting recurred in 1985. She resumed eating carrots regulariy and in the course of a single week, she ate 1 kg of carrots daily. Czrrots 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 panicularly in spring, when carrots lose much of their pleasant flavour 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 tuae, 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 follow- up. During ber 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 agaia When this was brought home to her, she managed to stop taking carrots in ume. A; presen; sne aas ae difficulties. Somaroneurological findings uere the norm. Her skin is orange in colour, espec;al:,: ,ne undersurfaces of her feet and her palms. A compiex e:amtnauon of the level of reunol, caroteno,as in general, and beta-carotene in the serum, as well as of some enzymatic systems including the determina- tton of the enzymatic activity of the following parameters was cart:ed out. The test battery applied here was recommended after a consultation with spectaltsts in internal diseases about the possibilities of rendertng certun biological changes. These tests cover the area of the description of liver, cardiac and neurovegetauve diseases recommended by the Ger- man Medical Chamber for the purposes of clinical diagnostics. In compliance with the results of enzymatic tests, metabolic disorders in the enzvma- uc pattern can be distinguished in great detall, and the pauent's metabolic condition as well as his disease can be monitored by methods non-aggres- sive in long-term applicauon. Our material shows a marked impairment of the pauent's enzymes. A particularly marked tntestfica- uon of activity has been found in aldolase (ALD) as well as cerebral creatinkinue (CK B) and hpase. Lower values in comparison with the norm were found in arylesterase (AE), alkaline phosphomono- esterase (AP), and cholinesterase (CHS). Her high carrot intake resulted in substantially higher values of retinol, beta-carotene and cazoteaoids in general. A predominant represenuuon of lycopeas and plant carotenoids were found in the serum. In evaluating the profile of the pauent's enzymes, it may be stated that the patient's dependence on carrots led to a metabolic imbalance. After a long- term monitoring of the padent's condiuon, 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 trdtment for multiple sclerosis. In spring 1988, he turned up at an anti-smoking advice centre in Prague asking for help to stop smoktng. 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 rec- ommeaded a substitute-fnut, or crunching some vegetables. She gave him carrots and he found that it helped him to forget about cigarettes. He was soon eating carrots constaatly, consuming up to five

I I I I I I I I I I I I I I I I I Can cu^rrots bc aadcc:c~e• .:9' bunches a day, and as it was spring he put himself to considerable expense. His craving for carrots be- came as urgent as his previous craving for cigarettes. Whenever the image of carrots entered his mind, or whenever he happened to catch sight of them, he immediately imagined himself eating them and started yearning for them. The consumption of carrots stopped his urge for something, and again he helped himself to carrots. If a sufficient amount of carrots were available, he would crunch them in rapid successton-this perfectly supplanted the ctgarettes and, in the same way, it was fised in his consciousness. He ate the carrots at home but also could not resist eatmg them in public. When he went shopping, he felt compelled to eat the carrots he had already bought on his way home on the train. The anu-smoktng advice centre advised him against such habitual carrot consumption. He imme- diately started doing his level best to give up carrots. Although the habit was not as strong as the dependence on ragarettes, it took him a long time to suppress it completely. He went on buying carrots throughout the summer-he was, however, con- scious of the necessity to be on his guard. It was only in autumn when carrots became rare in the market that he stopped eating them. In spring 1989 he did not feel compelled to indulge in eating carrots any more, though he continues to like them even now. After his visits to the advice centre he success- fully stopped smoking and abstained from it for 4 months. However, be relapsed after some stress situation at work. Discussion The three eaxs of raw-carrot abase described here are remarkable for giving rise to a psychic depen- deace, identical with drug addiction as defiaed by the WHO (1969), in all the three affected persons -two women and one ntat:. Tbe lack of carros made them lapse into a state of heightened irritabil- ity, nervousness. The withdrawal syndrome is so intense that the af9icted 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 depen- dence. The patient A. L. stated that the psychic difficulties caused by a lack of carrots were :ar more intensive than those called forth by a iack of cigarettes. The quality of difficulties is the same as in the case of smoking. The patient J. T mentione.i the same difficulues as the above patient but evaluated their intensity as somewhat lesser than ;n smoking. This patient, however, had not been consuming carrots for such a long time as the patient A. L. The ascertainment that raw carrots have the same effects as drugs of the nicotine type set me thinking what substance in carrots might be in- volved. The first to come tnto consideration was the biologically active carotene. For the tinx being, however, I cannot discount the possibility that catrots may contain another active substance conducive to drug addiction. In this area, experimentation seems necessary. This is why the aim of this communication is to draw the competent specialist's attention to this odd quality of carrots. A higher carrot intake resulted in a metabolic disorder particularly in the area of the auto-immunity system, the neurovegetative system and the central nervous system, as is the case in neuroses. The condition improved after giving up the consumption of urrots. Also the recurring relapse in patient A. L. was interesting-it was stmilar to that found. with other drug types. References 1. CoitiN, L. B. (1985) Observauon on carotenenua, Anxs<als of Internal Medicbtc,•48, pp. 219-227. 2. FtuiMeN, J. E. & JosOUS, A. Y. (1981) Benign carotenemia, Arcksfles of Diseaus in Childhood, 56, p. %5. 3. HvGtffd, J. D. & WoVTiN, R L. (1966) The orange people, Journal of tle Amencast Medical Assocuston, 197, pp. 730-731. 4. KiwG, C. & MtrneNo, G. (1980) Mysterious dietary bypercaroteaemu Clinical Research, 28, p. 231. 5. LAsCe1u, A. D. (1981) Carotenemu, Cluttca! Pedta- nus, 20, p. 25. 6. PATit, H., DtsNtt, H. G., TrsC31Ft, B. et al. (1973) Caroteneaua in mentally retarded children, Canadian Medical Assodano+t Jouraal, 108, pp. 848-852. 7. Sttocxru-a, Y., Sw•c_IAL, M., BEx-BARUCx, N., HmszoRrt, M. & Ptxiiseus, J. (1982) Neutropenia induced by hypercarotenemu, Lancet, i, p. 1245. 8. VArtt, D. V., Ay1oxAMrrts, A. & NuaMi, R. M. (1985) H7Pereatotenemia, Nusruu Research, 5, pp. 911-917. .. ~- .