Dietary supplements carry risks
According to the FDA, dietary supplements are regulated as food, but many have strong biologic effects or may even contain drugs.1 More than 18% of Americans use herbal or nutritional therapies as part of their health regimen.2 However, many over-the-counter remedies have been found to exhibit psychotropic effects,3 and many more are purported to impact mental and physical health with little to no scientific research into these claims or potential adverse effects.
Phenylethylamine is sold as a nutritional supplement and marketed for its purported beneficial effects on weight loss, mood, and focus.4 However, PEA is known to act as a natural amphetamine and to play a role in the development of neuropsychiatric disorders.5 It is an endogenous psychotogenic molecule that has been previously theorized as a cause for primary psychosis.6 Phenylethylamine interacts with the same receptor ligand that responds to amphetamine and related compounds (such as methamphetamine and 3,4-methylenedioxy-methamphetamine [MDMA]), the genetic coding for which is located in an area of DNA associated with schizophrenia: chromosome 6q23.2.7 While the mechanisms and details of these interactions remain poorly understood, this case of PEA-induced psychosis represents a glimpse into the potential psychoactive properties of this readily available nutritional supplement.
This patient’s cautionary tale has given me pause regarding both my family’s nutrition and the oft-neglected dietary portion of the social history. Also, several subsequent patient experiences hearken back to my mother’s words regarding the importance of healthy eating. A patient with phenylketonuria presented with psychosis after running out of her formula and consuming junk food. Another patient with severely elevated blood glucose levels presented with confusion. I have come to realize that ingestion impacts presentation, or, in other words, you are what you eat.