Case report

Carrot addiction
Robert Kaplan

Objective: A case report of carrot addiction is presented with a review of the

literature and comment on the role of beta carotene in addictive behaviour.
Clinical Picture: The addiction occurred in a 49-year-old woman under condi-
tions of stress due to marital problems, leading to a depressive illness and
increased smoking. The patient maintained that the sensations of carrot
craving and withdrawal were quite distinct from those associated with
smoking.
Treatment: The patient was advised to record her daily carrot consumption.
Outcome: The patient did not return for several months, but stopped eating
carrots after an operation, at which time she also stopped smoking.
Conclusion: Compusive carrot eating, regarded as a rare condition, has
received scant documentation, unlike hypercarotenemiadue to unusual diets
For personal use only.

or food fads. Nervousness, craving, insomnia, waterbrash and irritability are

associated with withdrawal from excessive carrot eating. The basis for the
addiction is believed to be beta carotene, found in carrots. Does carrot eating,
an aggressively oral activity, merely act as a behavioural substitute for
smoking? Or does beta carotene contain a chemical element that replicates
the addictive component of nicotine? Further study of this unusual but intrigu-
ing addiction may reveal more about the basis of all addictions, with particu-
lar implications for the cessation of cigarette smoking.

Australian and New Zealand Journal of Psychiatry 1996; 30:698-700

This report details a case of compulsive eating of
carrots, leading to withdrawal symptoms on cessa-
tion, consistent with psychological addiction.
Clinical picture
The patient, Mrs OA, a 49-year-old woman, suf-
fered from depression for many years. She first pre-
sented for psychiatric help in 1991 with problems
caused by an acrimonious marriage. The depression
manifested with feelings of guilt, a sense of failure
about her life and pervasive sadness. She slept
poorly, with middle insomnia, diurnal mood swings,
poor concentration and memory loss and weight
The Liaison Clinic, Wollongong, New South Wales, Australia
Robert Kaplan MBChB. FRANZCP. MA(Journ), Consultant
Psychiatrist
gain. She had lost her libido for several years, which
she attributed to her husband's adultery. Her mood
had worsened over the previous year and she had
transient suicidal ideation over the past month.
She was treated with dothiepin 225 mg per day and
supportive psychotherapy, to which she responded
well over the subsequent few months.
Towards the end of 1993, under considerable stress
after separation from her husband, she became
depressed again, started smoking heavily and lost
weight. She disliked smoking intensely but was
unable to stop. She was, however, pleased with her
weight loss and keen to monitor her diet to ensure
that she did not put it on again. Since childhood, she
had disliked eating carrots, especially cooked.
However, she started eating raw carrots when a
friend gave her recipes for low-calorie dips using
carrots as crudite's instead of celery. This progressed
 R.KAPLAN
to eating raw carrots alone when she went to bed at
night, and again when she arose in the morning.
This carrot eating built up into a compulsion where
she would eat 2-3 kg per day (at least 10 to 12 large
carrots) and neglect her daily diet. She rapidly lost
interest in eating any other foods. Attempts to resist
the craving were useless and she would get out of bed
at night to eat more carrots. Her activities began to
revolve around this activity, particularly the almost-
daily visits to the supermarket. She became an expert
in assessing the carrots, selecting them on size and
shape: features which would determine the woodi-
ness and succulence when eaten. As she put it: ‘I just
wanted to eat a nice juicy carrot and couldn’t stop
munching after that’.
She presented to me again in November 1994 for the
first time in 18 months, complaining of a recurrence of
her depression in response to the ending of her mar-
riage, disputes in court with her husband and financial
difficulties. Her depressive symptoms were similar to
For personal use only.
her previous episode. She was commenced on sertra-
line 50 mg with good effect. She responded well to
treatment and her mood had lifted by the end of the
year. Physically, she appeared normal and made no
comment to me at the sessions about her carrot eating.
In May 1995 she came to her next appointment
with noticeable orange/yellow discolouration of her
face and hands. She explained that the carrot eating
had overtaken her life and she had been too embar-
rassed to tell me about it at earlier visits. However,
the skin discoloration was now quite visible and she
felt self-conscious in public. In an attempt to over-
come the problem she had stayed with her parents for
several weeks, where they had encouraged her to eat
normal meals. However, the craving continued and
she became concerned about her appearance and the
loss of control.
In addition to the skin discolouration, she suffered
from a ‘tense and lumpy stomach’, abdominal pains
and diarrhoea. There was mild disturbance of sleep,
which may have been due to the sertraline. Her
weight remained constant.
Blood tests conducted at the time showed a normal
biochemical profile and thyroid functions (choles-
terol slightly elevated to 6.0 mmol/L); blood count
revealed a mild microcytic hypochromic anaemia
due to iron deficiency (Mrs OA had a long history of
anaemia due to chronic uterine bleeding). Serum
vitamin A level was 1.9pmolL (normal = 0.84-3.14
pmolL).
699
Advised to keep a daily record of her consumption,
she did not return for an appointment again until
August. She had been preoccupied with court appear-
ances related to her divorce settlement but was also
embarrassed by her inability to stop eating carrots for
more than half a day at a time. Attempts to stop
caused intense withdrawal symptoms. These includ-
ed anxiety, restlessness, shaking, craving, irritability,
insomnia and waterbrash. She despaired of ever
getting on top of the problem.
However, once the court proceedings had settled,
her gynaecologist insisted that she be admitted to hos-
pital for a long-postponed total hysterectomy to alle-
viate her uterine bleeding. The surgeon caused her
considerable concern when he told her that during the
operation her internal organs were observed to be a
bright yellow colour. She also learned that she was the
butt of jokes from the nursing staff. Discharged from
hospital a week after the operation, she was sick for
several weeks with intense loss of appetite, nausea,
weakness and tiredness.
Losing her appetite, she stopped smoking cigarettes
and eating carrots. The first few days lead to intense
cravings for both substances, which settled, followed
by cigarette cravings for a few more weeks. She felt
that the postoperative distress and nicotine withdrawal
symptoms had a combined effect which helped her
overcome her carrot craving. Within 4 weeks, she felt
she had overcome the carrot addiction, with cessation
of both psychological and physical symptoms.
Since then, she has maintained her abstinence from
both carrot-eating and smoking and believes that the
problem is behind her. She still gets the occasional
desire to smoke cigarettes. Aside from this, she says
that the idea of eating carrots in any form or prepara-
tion now repels her and she does not believe she will
relapse again.
Asked later about the distinction between cigarette
and carrot craving/withdrawal symptoms, she could
only describe subjective sensations, saying that she
‘knew they were different feelings’. She remains
emphatic that she could not have stopped eating
carrots without the discomfort induced by the nico-
tine withdrawal, as well as the postoperative debility
(chiefly the nausea).
Conclusion
Compulsive carrot eating, regarded as a rare condi-
tion, has received scant documentation. This is unlike
 700 CARROT ADDICTION
hypercarotenemia due to unusual diets or food fads,
references for which go back to 1919 [I]. Schoenfeld
et al. [2], for example, document a case of hyper-
carotenemia that presented with leucopenia due to
excessive ingestion of carrots and tomatoes. Other
references attest to the presentation of hypercaroten-
emia in cases of anorexia [3], hypothyroidism [4] and
Down's Syndrome [5].
While the excessive eating of a particular food may
be due to a food fad or eating disorder, the with-
drawal symptoms from compulsive carrot eating are
consistent with psychologically-based drug addic-
tion. Nervousness, craving, insomnia, waterbrash
and irritability are associated with withdrawal from
excessive carrot eating.
Cerny and Cerny [6] document three cases, seen
over a 34-year period. One woman started during
pregnancy when she substituted vegetables for fruit,
which she was unable to tolerate. In another case,
carrots were substituted for cigarettes, becoming a
For personal use only.
significant problem in their own right. The basis for
the addiction, the authors believe, is beta carotene,
found in carrots. They speculate that there may be
another element which causes the withdrawal symp-
toms, but this seems unlikely.
Beta carotene is the precursor of vitamin A.
Therapeutically, it is used at very high doses to treat
individuals with erythropoietic protoporphyria, an
inherited disease that causes extreme sensitivity to
sunlight [7]. Beta carotene is deposited in subcuta-
neous adipose tissue, leading to the harmless,
reversible colouration of the skin, especially the soles
and palms. It is regarded as extremely safe and does
not cause vitamin A toxicity [8].
Mrs OA's addiction occurred under conditions of
stress due to marital/divorce problems, leading to a
depressive illness (a condition she had previously
been treated for) as well as worsening of her smoking
habit. It should be noted that the antidepressant ser-
traline, while effectively treating her depression, had
no effect on the carrot addiction.
As with one of Cerny and Cerny's cases [6], the
link in Mrs OKs situation with smoking, both in
onset and cessation of the carrot addiction, was a
prominent feature. She was clearly in a low physical
state when she stopped using both substances. Yet
she remains adamant that the sensations of carrot
craving and withdrawal were quite distinct to her
from those associated with smoking. Furthermore, as
she maintains that she could not have stopped eating
carrots unless she was feeling so bad, the role of
smoking withdrawal in facilitating this remains
unclear.
Does carrot eating, an aggressively oral activity,
merely act as a behavioural substitute for smoking?
Or does beta carotene contain a chemical element
that replicates the addictive component of nicotine?
In Mrs OA's situation, was there a synergistic rela-
tionship between the two substances?
This author has heard several anecdotal reports of
similar cases. As this phenomenon is more common
than realised, further study of this unusual but
intriguing addiction may reveal more about the basis
of all addictions, with particular implications for the
cessation of cigarette smoking.
Acknowledgements
My thanks to Chris Monie, Medical Librarian at
Wollongong Hospital, for help with the literature
search, and to Susan Kaplan and Vijaya
Manicavasagar for suggestions and reviewing the
manuscript.
References
1. Hughes JD, Wooten RL. The orange people. Journal of
American Medical Associationl966; 197:730-73 1.
2. Schoenfeld Y, Shaklai M, Ben-Baruch N, Hirschorn M,
Pinkhaus J. Neutropenia induced by hypercarotenemia.
Lancet 1982; i:1245.
3. Sherman P, Leslie K, Goldberg E, Rybczynski J. St-Louis P.
Hypercarotenemia and transaminitis in female adolescents
with eating disorders: a prospective, controlled study.
Journal of Adolescent Health 1994; 15:205-209.
4. al-Jubouri MA, Coombes EJ, Young RM. McLaughlin NP.
Xanthoderma: an unusual presentation of hypothyroidism.
Journal of Clinical Pathology 1994; 47:850-851.
5. Storm W. Hypercarotenemia in children with Down's syn-
drome. Journal of Mental Deficiency Research 1990;
34:283-286.
6. Cerny L. Cerny K. Can carrots be addictive? An extraordi-
nary form of drug dependence. British Journal of Addiction
1992; 87:1195-1197.
7. Bendich AB, Machlin LJ. The safety of beta carotene.
Nutrition and Cancer 1988; 11:207-214.
8. Gerster H. Anticarcinogenic effect of common carotenoids.
International Journal of Vitamin and Nutritional Research
1993; 63:93-121.