Monday, April 7, 2014

Pine Nut Syndrome / Pine Mouth - Facts, Remedy and Cure

What is Pine Nut Syndrome (PNS) or Pine Mouth
Pine nuts can cause taste disturbances, lasting from a few days to a few weeks after consumption. A bitter, metallic taste is described. Though unpleasant, there are no known lasting effects, with the FDA reporting that there are "no apparent adverse clinical side effects."[1] This phenomenon was first described in a scientific paper in 2001.[2] Publications have made reference to this phenomenon as "pine nut syndrome" or as "pine mouth".[3] The NestlĂ© Research Centre has hypothesized that nuts from a particular species of pine occurring mostly in China, Pinus armandii, is the cause of the problem. The suspect species of pine nuts are smaller, duller, and more rounded than typical pine nuts.[4] 


  1. [1] "Pine Mouth" and Consumption of Pine Nuts
  2. Jump up[2] ^ Mostin, M. (2001). "Taste disturbances after pine nut ingestion". European Journal of Emergency Medicine 8: 76.doi:10.1097/00063110-200103000-00036.
  3.  [3] Christopher Middleton (May 2009). "Pine mouth puzzle: Why do these nuts leave you with a bitter taste?"Daily Mail. Retrieved 2009-09-01.
  4. Jump up[4] ^ "The Great Pine Nut Mystery".


Other PNS references

  • R. Hampton1, C. Scully1 & S. Ellison1    Pine mouth British Dental Journal 210, 151 (2011)   Published online: 26 February 2011 | doi:10.1038/sj.bdj.2011.102 
    • http://www.nature.com/bdj/journal/v210/n4/full/sj.bdj.2011.102.html
  • Pine nuts and pine mouth   Emerging issues paper June 2012  Prepared by the NSW Food Authority on  behalf of the Coordinated Food Survey Plan
    • http://www.foodauthority.nsw.gov.au/_Documents/science/pine_nuts_pine_mouth_emerging_issues.pdf
  • 'Pine mouth syndrome' leaves a bitter taste.  http://bodyodd.nbcnews.com/_news/2010/06/03/4452626-pine-mouth-syndrome-leaves-a-bitter-taste


First reported case of pine mouth
The first documented case of pine mouth in the scientific literature dates back to 2001 when
Mostin (2001) published an article in the European Journal of Emergency Medicine. He noted
that a colleague at the Poisons Centre in Brussels had experienced several episodes of taste
disturbance a few days after consuming pine nuts. The phenomenon was described as a
bitter, metallic taste disturbance usually lasting a few days. Since that time, this taste
disturbance has become referred to as ‘pine mouth’ or ‘pine nut syndrome’, however
medically it is known as dysgeusia, metallogeusia or cacogeusia (Zonneveld, 2011).

Symptoms
Accounts from sufferers of pine mouth indicate there is nothing at the time of consumption to suggest a difference with the pine nuts, they do not taste any different to ‘normal’ pine nuts. However, between 1 to 3 days after consuming the pine nuts the symptoms of the taste disturbance become evident and are usually described as a bitter or metallic taste which is exacerbated by the consumption of food and drink. The symptoms can last from a few days to up 2 weeks, although there are several anecdotal reports of symptoms lasting longer (up to 6-9 weeks) (Hampton, 2011; Tan, 2011). Prolonged duration of symptoms may possibly be due to ongoing consumption of pine nuts, with people not realising the cause of the taste disturbance.
While pine nuts are potentially allergenic, for all of the reported cases of pine mouth, the
taste disturbance is not due to an allergy, and symptoms are self-limiting with no long-term adverse health effects observed (Ballin, 2012). As such, while pine mouth is not considered a food safety issue in the traditional sense, reports from consumers suggest that the taste disturbance is quite pronounced, significantly decreasing appetite and enjoyment of food and causing considerable discomfort to the sufferer. There are also anecdotal reports of sufferers undergoing unnecessary medical scans (e.g. MRI scans and endoscopy) or being prescribed medication (eg antibiotics) because there is insufficient knowledge of the condition among the population and the medical profession to realise the cause (Tan, 2011). The degree of susceptibility to pine mouth appears to vary among people, as there are reports that consumers who eat pine nuts from the same batch may or may not experience the taste disturbance. Flesch (2011) and Ballin (2012) reported that females may be more frequently affected by pine mouth than males. Zonneveld (2011) found that it was necessary to consume at least six nuts (seeds) to bring on the bitter aftertaste, while Tan (2011) found that 2-3 seeds were enough to bring on symptoms. Ballin (2012) fed 6-8 pine nuts to volunteers and found that four out of six people developed classical symptoms. The severity of the symptoms may be dependent on the sensitivity of the person and the amount of pine  nuts consumed. Roasting pine nuts, or processing as in pesto, does not appear to make a difference and may still trigger the symptoms. Tan (2011) found that approximately 35% of cases also experienced other non-taste symptoms such as headache, throat and stomach discomfort, nausea and bowel disturbance.


Remedy / Cure for Pine Nut Syndrome or Pine Mouth
Cure for Pine Nut Syndrome 
Remedy for Pine Mouth
Treatment for Pine Nut Syndrome, Pine Mouth
Dr. Wang has researched this after he experienced PNS himself in 2014 and identified that the bitter after-taste is most likely due to some modified form of the fatty acid from affected pine nuts being deposit to the plaque on the tongue itself.   Thus when one eats or drinks, it activates the receptors, thus subjected them to over sensitization to such bitter-taste-causing chemicals. 
He identified that the bitter taste is most dominant in the back of the tongue, where there is the most plaque build-up. One would think the plaque and whatever in the plaque will be dislodged readily when one eats and drink, but in fact a dentist or good oral hygienist will tell you that tongue plaque is not readily removed without some manual effort.  
Dr. Wang recommends the use of a long and small spoon (e.g. those for ice-tea), or use the finger nail on your index or middle finger or a tooth brush or tooth brush fitted with a plaque removing ribbed rubber part. You would need to be patient - and while extending your tongue out  (flat) as much as possible, try to remove the plaque a bit at a time, and do it gently enough to avoid injuring your tongue or having a gag reflex.  You need to focus on the back of the tongue where you can see or feel the white plaque build- p and remove it a bit at a time and rinse it out with warm water. You need to repeat this till you get the majority of the plaque off. By now, you will notice that the spontaneous bitter taste is mostly gone. Now you can try to eat and drink something; and this time, you will find that the bitter after taste has largely subsided!!
A note of caution, the results might vary for different individuals depending on the severity and level of exposure to pin nut.   But I do believe that it will be effective in most cases in reliving the sensation.   If you tried it, I love to hear from you so I know if it works well for you or not. 
Remedy / cure provided by Kevin Wang, PhD.

Another new remedy for Pine mouth I have just developed is as follows:
(Update 9/25/16)
Buy fresh pineapple (whole, uncut  is best, or freshly cut up). 
Cut them into bite size, rinse them with water a bit, drain and store them in a food container with lid in the fridge.  
Between meals, rinse your mouth with water, then chew a couple of pineapple pieces at a time slowly for at least 60 sec. 
Trying to move the pineapple pieces around the mouth with your tongue as you chew them. You can then swallow them (or spit them out).   
Repeat that five- six time per session.  You can repeat this twice a day or daily - 
Try this routine for 5 days to a week. 
The principle behind this remedy is that pineapple has a enzyme - a protease that digests the protein receptors on the taste-buds - the same receptors that the pine nut chemical stuck to. So this way, hopefully the pine nut chemicals will be removed  and you will be symptom-free again!

Let me know if this new remedy works for you.  This will be very helpful to others.

Pine Mouth Remedy /Cure Update provided by Kevin Wang, PhD. on 9/25/2016

39 comments:

  1. I had same experience, lasted 2 weeks. Thank china for ruining my love of pine nuts.

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    Replies
    1. American pine nuts (those you get form local supermarket are fine).

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    2. I ate some from Winco and about a week later i was experiencing the symptoms of pine mouth.

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  2. i would never touch pine nut again. i thought i got cancer.

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  3. Thank you - your remedy for pine mouth seems to have worked for me. I have had the bitter taste in my mouth for 5 days now since eating pine nuts and it was definitely worse when eating and drinking. I used a spoon as suggested on the back of my tongue and now the bitter taste has almost gone.

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    Replies
    1. So glad it works for you.

      please repost it or spread the words.
      I might try to put it on You-Tube.

      K. Wang

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    2. I have just tried the spoon method and it has improved , thanks for posting this info on the web . I will continue with the method . I have eaten pine nuts in the past and have never had this problem . I'm in New Zealand . Not sure where the nuts come from as I bought it from a bulk container . But I will ask .

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    3. Hi Cecilia
      I have read that the round Chinese pine nut is causing this but not the longer Italian pine nut. I am also in New Zealand and my daughter has the problems with the pine nuts here. You will find that Italian pesto, which is normally made from pesto won't have any effect.

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    4. sorry I mean ....... made from pine nuts won't have any effect

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  4. So glad it works for you.

    please repost it or spread the words.
    I might try to put it on You-Tube.

    K. Wang

    ReplyDelete
  5. This comment has been removed by the author.

    ReplyDelete
  6. American pine nuts (those you get form local supermarket are fine).

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  7. Thank you for the advice I will try your remedy. I had a nut mixture from Cooperative (UK) which had lots of pine nuts in it. Fingers crossed and of course will never touch a pine nut again!

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  8. Thank you for the advice I will try your remedy. I had a nut mixture from Cooperative (UK) which had lots of pine nuts in it. Fingers crossed and of course will never touch a pine nut again!

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    Replies
    1. Pine nut is very delicious and nutritious. It does not happen very often.. it just happens some time to some people. I also resume eating pine nut too.

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  9. Dear Dr. Wang, thanks for the advice. The bitterness is not gone but it is certainly less annoying than before. I had at least 10-15 pine nuts as a snack yesterday so I think that my reaction is a bit severe. I just hope it will pass, some friends told me scary stories about tastebuds permanently damaged...just to cheer me up :-) thanks, kind regards. Ada

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    Replies
    1. Glad it helps. The effects are not permanent. Pine nut is very delicious and nutritious. It does not happen very often. Only when they mix in a batch from a bad source. And it just react strongly in some people. I also resume eating pine nut myself too. It has been fine. :)

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  10. It helped some. The taste isn't fully gone, but I would say 75% of the bad taste is gone. Thanks! I'll do some more scraping in the morning.

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    Replies
    1. Glad to hear that.

      Glad it helps. The effects are not permanent. Pine nut is very delicious and nutritious. It does not happen very often. Only when they mixed in a batch from a bad source. And it just reacts strongly in some people. I also resume eating pine nut myself too. It has been fine. :)

      Delete
  11. Dr. Wang, your scraping suggestion is the most effective of anything I've tried, and through repeated scraping, I've actually gotten rid of most of the bitterness. However, no matter how much I scrape my tongue, my (sweetened) coffee still tastes bitter. Maybe there is something about coffee. Nonetheless, I really thank you for your mostly effective cure!

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    Replies
    1. Eve;
      I believe there are likely some residual molecules binding to the taste receptors on your taste buds (e.g. bitter, sweet) - and messing things up. - it will get better over two weeks. good luck. Thx for visiting my blog.

      Delete
    2. Thanks again. I think you're right about the residual molecules. Actually by the next day, after scraping again that night and also trying to rinse my mouth out with Listerine and then oil (gross, but maybe helpful) I was able to drink coffee in the morning without bitterness!

      Delete
  12. This actually improved it for me. It was noticeably better when I used the back of my toothbrush to clean my tongue. I had pine nuts that caused this a couple of years ago and after having them unknowingly again this week I was prepared for another couple of weeks of it. Thank you so much Dr Wang.

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  13. Thanks, this worked for me so far. Ate a small handful on Friday. Could not figure out what was wrong. Then my 18yr old daughter had the same issues. It is a week later and I still had the issue until I tried your remedy. We will see if it continues to work. I am hopefully and optimistic.

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  14. Thanks, this worked for me so far. Ate a small handful on Friday. Could not figure out what was wrong. Then my 18yr old daughter had the same issues. It is a week later and I still had the issue until I tried your remedy. We will see if it continues to work. I am hopefully and optimistic.

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  15. thanks for trying the remedy. once it subsides, it generally won't come back. Also, it is not harmful or permanent - just persistent and annoying.

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  16. Hi, I'm just posting to confirm that this method also helped me. I was unable to get to the very back of my tongue, so there is still a slight bitter sensation there, but the bitterness has significantly decreased overall, allowing me to enjoy eating food and drinking water again.

    I was thinking earlier this morning it would be interesting to combine pine mouth and miracle fruit to see what the combined results are on the taste receptors.

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  17. The source of my pine nuts claims to be the pinus sibirica (Siberian Pine) in Russia, but I wonder if it is true. Will contact Trader Joe's to double check. Can the bitterness also be caused by other types of pine nuts??

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  18. Thanks for writing. yea. it is vey common they the pine nuts are from mixed origins. There are over 30 species of pine nuts - some have this problem and some don't. It is good to ask Trade Joe. But most likely they might not even know the exact source(s) for sure. I love pine nuts, so I still eat them. the sensation does not cause any long term damage :) So happy eating!

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  19. I just found your blog. I have had pine mouth since mid-May, after eating a small amount of pine nuts in a pesto. The bitterness is not as extreme as it was during the first month, but is still very noticeable and unpleasant. I can no longer drink coffee or wine, for example. I have tried scraping my tongue, to no avail. I told my doctor about it and she just looked at me blankly. I am starting to think it's permanent! Any advice for me? Thanks.

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    Replies
    1. hi, just saw your note. Sorry to hear that you had a long lasting pine mouth symdrome. I think you are just very sensitive than most. It will eventually go away. But to acclerate it, I would recommend trying more - scraping - every other day for a week.
      Another new remedy I am developing is as follows:
      buy fresh pineapple (whole, uncut is best, or freshly cut up). Cut them into bite size, rinse them with water a bit, drain and store them in a food container with lid in the fridge. Between meals, rinse your mouth with water, then chew a couple of pineapple pieces at a time slowly for at least 30-60 sec. Trying to move the pineapple pieces around the mouth with your tongue as you chew them. You can then swallow them (or spit them out). Repeat that five- six time per session. You can repeat this twice a day or daily - try that for 5 days to a week. The idea is that pineapple has a enzyme - a protease that digest the receptor on the taste-buds - the same receptors that the pine nut chemical stuck to. So this way, hopefully the pine nut chemicals will be removed and you will be symptom-free again!
      Let me know if this new method work for you.
      good luck!

      Delete
  20. My pine nuts came from WinCo too, and also appear to be Chinese in origin. I first developed pine mouth this year, from the same batch I bought last year, which I originally had no reaction to, despite eating tablespoons at a time, plain and toasted. I stored them vacuum-packed in the refrigerator.

    I used a tongue-scraper as suggested and it did indeed speed up "decontamination" quite a bit.

    It's interesting that a tongue cleaning works, because I was likening the effect to that of the miracle berry, which sticks to your tastebuds for a short time and makes sour taste sweet. The affected pine nuts seem to stick to your tastebuds for days and make everything taste like pine sap.

    Thanks K.W.!

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  21. FYI, It's not just taste, it's smell also. I've been a Pine Nut addict for about 2 months and have been fine. However, I ate some yesterday, and about 24 hrs later today, I ate 2 bites of a chocolate chip cookie, that someone else made, and it tasted and smelled like rotting animal... not that I've ever tasted one, but that's what I'd imagine one tasting like. (Most of the ones I ate were roasted in olive oil, and I only at a few fresh ones) I thought that perhaps the cookie dough they used or the oil was bad or something. However, 3 other people ate the cookies and said they were fine.

    I, on the other hand, went and literally "tossed my cookies", or at least the little bit of cookie that I did eat, then brushed my teeth and tongue, and gargled with mouthwash, but couldn't seem to get rid of the taste from the cookie. I then washed my mouth out with water, then pop, and gargled with pop, which mostly got rid of the taste, but I still had some of the taste lingering in the back of my tongue and even throughout my sinuses.

    After going through all of that, I then asked my daughter to bake our store bought cookie dough, which was surely not expired. As they started to bake, I could smell them and they smelled foul. That's when I realized the problem wasn't the first cookie that I ate- The problem was me.

    I thought I was going crazy or that something was really wrong with me. I knew about Pine Nut Mouth, but didn't think that was the cause, especially because the Pine Nuts that I ate yesterday were from the same batch I had at from several times prior, but the more I read about it, the more I believe that's what it is. However, I find it really strange that no one noticed the smell of certain foods being an issue.

    After the cookie incident, we baked a cheese and tomato pizza to see if that would be any better, and the smell was nowhere near as bad as the cookies, and it was much more tolerable to eat. However, there was a slight tinge of that foul taste, especially with the crust.

    One other thing I noticed is that the smell of cigarette smoke had smelled a bit like the cookies. However, when I closed off my breathing through my nose, it didn't taste any different.

    On thing is, I drink Mountain Dew chronically. It's the sweetest, most sugary drink on the market. However, it tasted 98% fine in comparison to the 0% with the cookie. Perhaps it's because of all the citrus in it. Who knows?


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  22. Just bought some pine nuts from a WinCo over in Washington state. They are definitely the chinese variety. Made pasta with them on October 30, 31, and November 1. Today, the 2nd, everything tasted so bitter that I simply couldn't eat - filet mignon (with only butter, salt, and pepper) tasted foul, mashed potatoes were foul, coffee was something straight from hell, and some chocolate cookies and ice cream were the biggest mistakes of the day. Oh and my milk tasted expired.

    This post was very helpful! I have a metal tongue scraper, but I can't get all the way back (gag reflex). However, I tested mashed potatoes again after scraping as much as I could, and the bitter flavor was noticeably less! I could actually eat those! Thanks for the tip! I will be on a mashed potato diet until this begins to subside.

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  23. thanks for the feedback.

    I posted a new method on 9-25-16 (see above)
    It involves chewing fresh pineapple chunks. It contains an very powerful enzyme (a protease call papain) that will digest the proteins on your taste buds. Hopefully the digested protein will be washed away from the tongue along with the metal taste-chemicals.

    Give it a try and let me know if it helps.

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  24. Thank you... Thank you... Thank you! The spoon trick made it much better! I though I had ingested something horrible.

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  25. check out this FDA link: on
    "Pine Mouth" and Consumption of Pine Nuts

    https://www.fda.gov/Food/RecallsOutbreaksEmergencies/SafetyAlertsAdvisories/ucm247099.htm

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  26. check out his article form LA times
    "Ever heard of 'pine nut syndrome'? Neither had I, until I got it"
    July 22, 2014
    by Robin Abcarian

    http://www.latimes.com/local/abcarian/la-me-ra-bad-taste-in-my-mouth--20140722-column.html

    ReplyDelete