Citric acid intolerance (and acetic acid): a metabolism disorder

I may have identified the root cause and discovered the remedy to a medically unidentified disease known on the web as Citric Acid Intolerance. Here’s the story and the remedy. I hope it helps you.

Discussed in this post:

My initial symptoms and diagnosis

In my mid-twenties I began suffering terrible, painful abdominal problems that I soon attributed to acid foods. That theory mostly held but not always. I could only live my life, get out the door, and not constantly worry about finding the nearest bathroom by keeping a strict diet of completely plain foods.

Plain, as in, baked or grilled or steamed; no seasoning but salt; no complicated ingredients;  water or seltzer to wash it down. That could mean a burger with lettuce, no sauces, no tomatoes and no onions. It meant a salad of lettuce, carrots, and cucumbers with oil but no vinegar. It’s harder than it sounds and eating was difficult. Eating at a restaurant was nerveracking. I ate like this for years but at least I got some of my life back.

All the while I disagreed with doctors who diagnosed me with IBS (irritable bowel syndrome) and were lobbing random medicines to see what worked, including prescription medications with side-effects and even antacids. One doctor told me IBS was “a wastebasket diagnosis,” meaning if they did not know what the digestive problem was, it was IBS. I was not content with this hopeless life sentence. Since I had some control over the symptoms through diet, I had reason to believe there was a pattern that hadn’t been identified.

Isolating Citric Acid and Acetic Acid

I was Buddha-like in my dietary vigilance and therefore was able to test methodically. Since my plain diet left me symptomless, I was able to use this to determine what specifically was affecting me by adding on occasion a questionable ingredient to my food and assessing the outcome. A few key things became clear:

  • Upon ingestion of problem foods and ingredients, symptoms did not manifest for at least a day, usually two. This happened consistently suggesting that my problem was not a digestive problem. If it was, the pains would have come within hours not days.
  • There were ingredients and foods that were affecting me that at the time I did not consider acidic included sushi (not sashimi), mayonnaise, and canned foods like artichokes hearts and beans (but not all brands, surprisingly).
  • There were ingredients and foods that I thought would affect me but didn’t such as coffee, apples, grapes, black pepper, and soy sauce (without naturally occurring alcohol).
  • Foods and ingredients previously suspected were confirmed to be problems, such as tomatoes (especially cooked or canned), onions, mustard, sodas, and salad dressings.

Since initially this did not entirely make sense, I kept track of every ingredient in every can or jar of whatever I was eating. I also researched fruits and vegetables to determine what exactly was inside them. Eventually this led me to my first discovery: there were only three things affecting me: citric acid, acetic acid (vinegar), and alcohol.

At first I thought citric acid was specifically the issue, so I began my internet search to figure out if anything had been written about such a problem, what could be done, and who else is suffering from it. There was not a lot out there but what I found was:

  • The citric acid cycle is a critical metabolic process for energy production in organisms and occurs at the cellular level. Says Wikipedia’s Citric Acid Cycle page, “This series of chemical reactions is central to nearly all metabolic reactions, and is the source of two-thirds of the food-derived energy in higher organisms.”
  • There is a lot of talk about citric acid allergies, which is not the same thing. Allergic reactions are an immune response that usually manifest immediately, not a day later.
  • Eventually I discovered Vicky Clarke’s page on what she calls Citric Acid Intolerance, a brave woman from England – the one person that corroborated my suspicions and documented her very similar (albeit more severe) plight in great detail. To find someone else who had been on this journey made me realize I was not imagining things – I was right! I wish I knew how to reach out to her to say thank you.

The Citric Acid Cycle, the metabolic connection

Note the Acetyl and Citrate, resulting from Acetic Acid and Citric Acid, respectively, and their relation to Coenzyme A (CoA). Credit Wikipedia, authored by Narayanese, WikiUserPedia, YassineMrabet, TotoBaggins
Note the Acetyl and Citrate, from Acetic Acid and Citric Acid, respectively, and their relation to Coenzyme A (CoA).
Credit Wikipedia, authored by Narayanese, WikiUserPedia, YassineMrabet, TotoBaggins

Eventually I deduced that the problem was dysfunctional metabolization related to the Citric Acid Cycle. Continued research showed that alcohol broke down into acetic acid, and both citric acid and acetic acid are integral to the Citric Acid Cycle (Krebs Cycle), specifically with relation to interactions with Coenzyme-A, a critical component of the the cycle. I surmised that this process was malfunctioning within me.

Of course, I was not entirely sure and this line of thinking was probably a stretch considering my limited medical knowledge. However, it is a hypothesis that I feel I have since adequately proven.

(Furthermore, I believe the outcome of this Citric Acid Cycle malfunction is the production of an irritant that was causing the pain. I later found a research paper linking elevated levels of pyruvate from the citric acid cycle in stool samples from patients with IBD (inflammatory bowel disorder), so this part of the hypothesis is not without reason but not proven.)

With the confidence that the Citric Acid Cycle was the issue I turned to another part of the puzzle I had discovered, that vitamin B5 had beneficial effects that eased my symptoms. Regular intake offered some flexibility in my food consumption but not much.

Vitamin B5 and Coenzyme A

At around the same time I was discovering the benefits of vitamin B5, Vicky Clarke updated her page to include mention of the same. More vindication; I was on the right path!

Research into vitamin B5 revealed something that gave me further confidence in this direction. Vitamin B5, known as pantothenic acid, is also a critical component of Coenzyme A synthesization. One more thing pointing to the Citric Acid Cycle.

Coenzyme A is not like the lactose enzyme; you can’t just ingest coenzyme A, your body has to make it. So I needed to determine what supplements were necessary to help my body create more coenzyme A. I was fortunate to find that there was one lab that creates an over-the-counter supplement engineered for this, called Pure Coenzyme A. Although marketed as an energy boosting aid (and obviously not containing pure coenzyme A), it had the combination of supplements needed including pantothenic acid, pyruvate, and amino acids. I had nothing to lose by trying.

Testing the theoretical remedy

I took one pill daily for three months before I experimented with eating citric acid- and acetic acid-rich foods. I still remember the terror of eating that first pizza slice. At that point I had not eaten pizza in years and so savored it, all the while dreading what may happen in a day or two. But the pain never came. It never came!

As an extension of my food testing, for the next few weeks I experimented with one problem ingredient or food every few days. Eventually I hit a limit of how much I could eat but even then the pain wasn’t so bad. So I started taking two pills a day. And then even that limit broke.

After a while two pills a day was too much and I moved back to one a day. There are days now that I skip the supplement intake entirely. I still need to take it but I have no dietary restrictions anymore. I eat everything without concern. There is no more pain.

Success!

I repeat: I have no dietary restrictions at all. None at all!

Ten years after I first experienced symptoms, I got my life back. I’m a few years in from that point and still doing great.

And I want you to have your life back too. So here are my suggestions if you think you’re suffering from the same thing.

Disclaimer: I am not a medical professional. While none of what I discuss involves prescription medications or medical procedures, please don’t take my assumptions as doctrine and do contact a doctor if you have concerns. While doctors have never heard of this problem, they can at least tell you if the supplements I’m suggesting are okay for you to take. Also, if there are errors in my thinking, I would appreciate clarification to refine the theory. While I did confer with a biologist who agreed with some of my assumptions, I’ve only tested this on me.

How to determine that Citric Acid Intolerance is your problem

Testing and identifying whether you have problems with the Citric Acid Cycle is the first step. It might also be the hardest. As mentioned, problem ingredients are found in many, many foods so isolating requires significant determination but it is possible to do.

Know the foods and ingredients with citric acid and acetic acid

  • Many canned foods use citric acid as a preservative and it’s usually, but not always, listed in the ingredients. Example: artichoke hearts or canned beans.
  • Vinegar is mostly acetic acid. Anything containing vinegar is going to be a problem, including sushi which contains rice wine vinegar in the rice.
  • Alcohol breaks down into acetic acid, as mentioned previously.
  • Many vegetables, especially when cooked, have high concentrations of citric acid, such as tomatoes and onions.
  • Citric fruits such as oranges, lemons, and pineapples have high concentrations of citric acid.
  • Most condiments have any one or more of the following: citric acid, vinegar, tomato, onion (or onion powder), or citric fruit juices.
  • Powders derived from onions, celery, or the any substances derived from ingredients that are a problems in another form.
  • Honorable mention: Phosphoric acid. This is an artificial acid and I have not researched why it is problematic but testing has shown it is.

Know what foods do not have citric acid or acetic acid

  • Fruits such as apples and grapes are fine in moderation because they have tartaric acid not citric acid. Bananas are also fine.
  • Sodas that use tartaric acid (from grapes) instead of citric acid, like Blue Sky organic cola, for example.
  • Proteins, plain or mildly seasoned with foods not ordinarily a problem (e.g. herbs).
  • Nuts too are fine.
  • Soy sauce is one of the few saucy condiments that does not have problematic ingredients. Just be aware of those with naturally occurring alcohol mentioned on the label.
  • Dairy. If lactose intolerance is a problem, it is a separate issue and can be managed with over-the-counter supplements.
  • Sugary items, such as cookies and cakes without problematic ingredients are fine.

Fortunately there are several sites that offer Citric Acid free recipes but I highly recommend sticking to plain foods to better isolate ingredients. Here are a few.

Testing to determine if you suffer from Citric Acid Intolerance

  • Test yourself by STRICTLY limiting your diet to plain foods with very few ingredients. If you were unable to stabilize your digestive problems then either Citric Acid Intolerance is not your problem or you have not been as strict with your diet as you need to be.
  • Stick to plain foods and water until digestive issues have stabilized.
  • Keep a diary.
  • Introduce one food with either citric acid or acetic acid. Eat once, don’t eat anything else with citric or acetic acid, and wait a few days. Document the reaction.
  • Over time there should be a pattern showing you that citric acid and acetic acid are without question the cause of your problems.
  • Now stop testing and return to a plain diet.
  • Start taking the over-the-counter supplement, if it’s okay for you to do so. Pure Coenzyme A is not commonly found everywhere but you can certainly order it from Amazon. Also, most of the components of Pure Coenzmye A can be bought separately more easily if preferred.
  • Take for a month or more before you start the food testing again.
  • After a month or more, introduce one known problem food or ingredient. As before, eat once, then stick to plain foods, and document the reaction over the next few days.
  • If there is a difference in your reaction – notably, if you have no reaction – things are working.

I hope this works for you. Please let me know if this information has helped you in any way. Wishing you the best of luck and good health.

Dying without suffering is an intelligent and compassionate option

Jack Kevorkian’s death has stirred much emotion in me. Millions of individuals around the world believe he was a champion for compassion, intelligence, and humanity. Millions more believe he was the opposite. I think he was a champion and here is why:

My father died of brain cancer late last year. He had spent most of his life helping others, yet suffered needlessly before he died. His brain tumor, a glioblastoma, had been treated with chemotherapy and radiation until its progress had slowed. Being an incurable malady, the result was a suffering prolonged.

One would imagine acknowledging the reality of dying is a sign of a mature society. When we had no control of sickness or death such decisions never needed to be made. Yet when we learned to extend life we inconceivably used it greedily, never applying rational countermeasures and limits on such powers or thinking through the wisdom of indefinite treatment. Science’s regular confrontation with ancient mythology has created a system of suffering and cruelty. Politicians and religious figures defend this practice by referencing fictional horror stories of abuse and in the name of faith remain unwilling to think. Abuse would have to be managed. And thought is surely a gift from god, so why fail at such an important task?

When my father was capable of thinking more clearly he had requested of me to let him die when all hope had been lost. He was exhausted from the daily difficulties brought on by the tumor and tired of the loneliness that comes with debilitating disease. I never told him that there had never been much hope because it would have been harder for him to accept the unending medical treatment that he had no choice but to undergo. While our family hoped for the best, his death was the only certainty, and yet his request could not be acted upon and so in the end all I did was lie to him about hope.

Gary Carter, the Hall of Fame baseball player, revealed he has a glioblastoma. He will take the chemotherapies Temodar and Avastin, he will take steroids to reduce brain swelling that will also atrophy his legs, he will undergo radiation, he will do the things that humans have done with cancer for nearly a century. However, unlike so many of the challenges Gary Carter has met in his career, he will not win this one.

My father did not win, Ted Kennedy did not win, my upstairs neighbor did not win, my friend’s father did not win, and Gary Carter has no chance either. This “rare” brain disease is becoming common. Not only will humanity need to acknowledge environmental factors as cause for its increasing prevalence, humanity will need to accept that death by cancer and other terminal diseases must be met rationally with maturity and compassion.

The day before my father went into hospice a doctor at the hospital, who had also lost his father to cancer, confided in me that the worst mistake he made was making his father go through chemotherapy. Dying without suffering, with dignity, is an intelligent and compassionate option and should not only be a privilege for pets.

Had there been options, I would have spoken to a doctor or counselor to consider fulfilling my father’s request to die before the suffering. My father would have been able to make peace with me and say goodbye to his friends, instead of staring at us frustrated, his eyes showing complex thoughts but his mouth unable to formulate words. When he could still articulate his thoughts, my father made the decision to die and he made that request rationally, but I had to ignore it. Under our system, I watched a harmless man suffer needlessly and I facilitated that as his powerless health advocate.

I am sorry, Gary, for the journey you are about to take. And thank you, Jack, for having the guts to show us there is a better way to respect our dying. You’ll both be missed and I hope your legacies will make a difference in bettering humanity.

The difference between community and neighborhood

Moving to a small area in Brooklyn in my mid-twenties was the first time I made the distinction between neighborhood and community. In common language and on the news, the words are often interchanged but they are not remotely similar.

A neighborhood is a collection of people geographically bound by some physical or official designation such as a street or border. Neighborhoods might be friendly but not productive. A neighborhood exists physically but the people do not necessarily have any connection with each other despite their close proximity.

A community does not require physical boundaries but its members, either actively or passively, work to produce something, like nurturing schools or a friendly environment. In community, acts of friendliness may be performed regularly to help neighbors and people may just stop on the street to chat to people whom they are not connected to via social media. People in communities care for one-another, something not necessarily present in a neighborhood.

When I lived in a certain part of Queens I never knew there could be anything different from a neighborhood. There were people everywhere but no one spoke to anyone caringly. I lived on the same street for decades and knew few people on the block. Very little was done collectively to improve the overall circumstance.

In this part of Brooklyn people say hello, gather at people’s homes, share things and have a willingness to give and help. Businesses are supported by locals out of pride and solidarity. Email groups bind residents together with the dissemination of information, stories of personal experience, and freecycling offers. Families are important and not just to the family members. Most staggeringly, people care, in general, as a way of life, about their blocks, streets, and neighbors.

Can communities be constructed? Surely seeds can be planted but to aggregate a caring people with similar ethics may simply be a matter of luck.

How does one find a community? Communities are now often bound by online information distribution through groups, forums, or fan pages. I would begin my search by seeking those out.

How do you know when you’re in a community? A friend of mine once said, “I love that kind of stuff, where people are friendly and it’s not all about ‘me, me, me’ but feels like part of a community.” If you feel like you’re part of a community, you’re probably in one.

What is the single most important factor in sustaining a community? The absence of anger.