Spilling The Beans About Fava Beans, A Sequel: Fava Bean Abuse

Read Sharon Packer, MD's initial article on fava beans, "Fava Beans, Dopamine, Depression, and Parkinson Disease."¹

When “Robbie” returned to New York with medical records in hand, I was happy to see him in my waiting room again. He arrived early, as always.

Robbie was what one might call “a character.” Even in the heat of summer, Robbie wore a fedora, which was once white and was now sprinkled with grey soot, thanks to the grimy city subways. When he was not on the road, pursuing his wanderlust, he lived in a furnished room at the fabled Chelsea Hotel, where other “characters” congregated.

I had long suspected that Robbie had bipolar II disorder rather than pure depression, and that he used his frequent absences while traveling to conceal his upswings, and to avoid prescriptions that might stop those spurts of energy and episodes of excitement-seeking.

He had a city job paid, which paid well enough, but did not demand too much, and so he wrote cookbooks at his desk during downtime. In other words, when he was not working, he was writing. And when he was not cooking, he was drinking. Often, those activities overlapped. He wrote when he worked, and he drank while he cooked. Luckily, his civil service job was secure and did not interfere with his preferred pastimes. Plus, it offered ample days off.

Prior to returning to my NYC office, Robbie had been traveling through Morocco and elsewhere in North Africa, off on a Paul Bowles-style excursion. Robbie was an aspiring writer, and Paul Bowles was an inspiring writer, and so it made sense that he wanted to trace the tracks of his literary idol. He wanted to publish on more serious subjects and did not see his cookbooks as his end game. The fact that Paul Bowles wrote dark and dismal stories about The Sheltering Sky (1949) made the author extra appealing to someone like Robbie, who battled with depression for much of his adult life and who repeatedly struggled to stop drinking, sometimes with impressively long stretches of success.

Robbie was by no means the only Paul Bowles’ fan out there. Rather, the American ex-pat author retained a cult following for decades after his death. Many admirers made pilgrimages to Bowles’ old haunts in Tangier, where he had lived for half a century. Bowles had influenced the Beat Generation and welcomed unlikely figures like Alfred Hitchcock. Should one tire of Bowles’ legacy, many more literary legends had passed through Tangier, adding to the appeal of the once lawless Moroccan city that was famed for its hashish supply and for attracting outlaw literatees like Williams Burroughs and Jean Genet.

So, when Robbie held out his left hand, to hand me his Moroccan hospital records, I half-expected to see that he had been admitted for detox or another alcohol-related event. I could easily envision his having fallen off the wagon, traveling alone in an unfamiliar environment. There was some consolation in knowing that alcohol was not easily available in his chosen destination, because of religious restrictions in North Africa. Since Robbie had never expressed interest in intoxicants like cannabis, hashish, or heroin, which could be easily acquired, if current rumors or historical accounts were correct, he seemed safe.

But no, as chance would have it, his discharge papers made no mention of alcohol. Nor did any common psychoactive agents appear in his toxicology reports. The discharge diagnosis was “favism.” I could not read most of the records, which were in Arabic, interspersed with some French. Fortunately, “favisme” in French mirrored the English term. I made some sense of the lab reports, but still, I could not make sense of how he developed favism in the first place. With his sandy hair and freckled face, he did not look in the least bit Mediterranean, Mideastern, Asian, or African—the groups most at risk of favism because many carry a G6PD gene that increases the odds of developing the hemolytic anemia of favism, should they ingest fava beans.

The quizzical expression that formed on my face must have been obvious, for Robbie elaborated, without my asking. “Yeah, I had no I idea that I had this disease if that’s what you call it. And they didn’t explain much, and even if they tried, I couldn’t understand Arabic.” I presumed that he was alluding to G6PD deficiency, which appeared in the labs.

When I told him about the link between G6PD deficiency and favism, and mentioned the ethnic prevalence of this recessive gene, he perked up, and elaborated, “That makes sense, since my mother’s side came from Italy, by way of Tripoli, even if I don’t look it. It was my father’s side that was Irish.”

Despite the ambiguity about other matters, it was crystal-clear to me as to how he could come across copious amounts of fava beans during his North African sojourns. Ful Madamas, a porridge made from fava beans, and flavored with onion and garlic, and other savories, was the breakfast of choice in many Levantine countries and even in some East African locales. Ful was the national food of Egypt, akin to an Egyptian version of Wheaties, that one-time American “breakfast of champions” that was displaced by granola.

Every medical student learned about fava beans in pharmacology class. These dopaminergic beans, which contain L-DOPA, are taboo for persons treated with MAO-I antidepressants because they could cause catastrophic spikes in blood pressure. Luckily, Robbie had never been treated with these old-time antidepressants, even if he sampled so many other meds. To avoid instilling panic about MAOIs, I sidestepped this discussion. Instead, I made an offhand remark about those Middle Eastern breakfast traditions, and then said, “to develop in favism in such a short time, I would think you’d have to eat fava beans for breakfast, lunch and dinner.” And he retorted, “That’s exactly what I did.”

Robbie went on: “I really liked the way it made me feel. It perked me up, so I kept eating more and more beans. They were cheap. They were everywhere. And somewhere along the way I got excruciating pains and wound up in the hospital. They tested me and told me that I had ‘favism.’ Never heard of it before. And that is when I learned about my G6PD deficiency. Never heard of that before either. And I still don’t fully understand it.”

As I listened, it clicked. Robbie had a gene that caused G6PD deficiency. e HeHe also acquired an affection for fava beans, and easy access to the fava beans and so he developed favism. Since fava beans contain L-DOPA, which becomes dopamine after entering the brain, psychoactive effects can follow but are more potent in someone with preexisting bipolar disorder. Dopamine is energizing and may possibly relieve depression, but dopamine itself is also associated with addiction because it is so reinforcing. Robbie was describing textbook-style addictive behavior, for he continued to use a psychoactive substance despite the physical distress it caused.

Searching the literature, I found reports about trials to treat Parkinson disease (PD) with fava beans. The L-DOPA content of the beans is equivalent to medicinal L-DOPA, which is the standard pharmaceutical for PD. There are anecdotal reports and some small but not-completely controlled studies about fava beans’ utility for relieving depression. For someone like Robbie, it was feasible that the beans’ dopaminergic effects catapulted him into a hypomanic state that made him feel so good.¹ Someone without this biological predisposition might not have had so intense a reaction to the beans’ low dose dopamine.

Robbie’s reaction to fava beans now made sense. It also made sense that someone with pre-existing addictive behaviors—alcohol overuse—would be more likely to overuse another psychoactive substance, this time in the unlikely form of fava beans. Luckily, Robbie was not disappointed to learn that fava bean-based snacks or breakfasts are not readily available in the US. In fact, he ended his appointment by assuring me that he had no intention of adding fava bean recipes to his forthcoming cookbook.

“And what will that next book be titled?” I asked. “A Sixpack and a Potato,” he said.

Dr Packer is an assistant clinical professor of psychiatry and behavioral sciences at Icahn School of Medicine at Mount Sinai in New York, New York.

Reference

1. Packer S. Fava beans, dopamine, depression and Parkinson disease. Psychiatric Times. July 10, 2025. https://www.psychiatrictimes.com/view/fava-beans-dopamine-depression-and-parkinson-disease