Dr. Guernsey writes, “General symptoms are common to every disease and almost every drug, the uncommon sensations and pains, likes and dislikes are simply the ‘guiding symptoms’ to the choice of the remedy that will often be found to cover the ‘Totality of Symptoms’ in the case” [1] Desire means a strong feeling of wanting or urges to have something or wishing for something to happen, whereas craving is an expression of neediness. Aversion is a strong dislike or disinclination towards one or a group of things  [2]

Development Of Food Preferences:

The development of food preferences begins before birth. The taste sense develops and matures at an early stage, of gestation. First taste bud appears at 8^th week of gestation. Aroma compounds in the amniotic fluid stimulate the foetal taste receptors as soon as the foetus starts swallowing (around 12^th week of gestation). During 26-28 weeks of gestation links between the stimulation of taste receptors and reflex type changes in facial expression can be detected [3-5] 

The intake of food is determined by physiological hunger, as well as psychological and cultural factors that modify the appetite. [6,7]

• PHYSIOLOGICAL FACTORS: Physiologically it is regulated by the following:

HYPOTHALAMUS:The hypothalamus responds to circulating signals of hunger and energy balance and tells us to drink when we are dehydrated, to eat when our bodies are running low on calories. It helps us to achieve homeostasis. 

AMYGDALA: It is a Greek word, stands for almond. A key part of emotional regulation, controls our reactions to events that are keys to survival. Basolateral area of amygdala is responsible for allowing learned cues to control eating. This means when we see a cue for food, we respond by eating. Eating behavior is mediated by connectivity between the basolateral amygdala and the lateral hypothalamus 

HIPPOCAMPUS: It is located in the temporal lobe, filters sensory data and puts it in short and long-term memory. The memory for the location of a highly rewarded substance like chocolates, cookies is rarely forgotten.

• PSYCHOLOGICAL FACTORS: Psychological factors can also influence the intensity and nature of our food craving. Studies on mood have found that our emotional state normally has a great impact on cravings than hunger. It is regulated by the action of Dopamine and Serotonin. Serotonin is a happy hormone and Dopamine is a Feel-good hormone.

•  THE FACTORS INFLUENCING OUR FOOD CHOICES:  Food choice is influenced by a large number of factors. The key driver for eating is of course hunger but what we choose to eat is not determined solely by physiological or nutritional needs. Some of the other factors that influence food choice include: [8]

• Biological determinants such as hunger, appetite, and taste.

• Religion having diverse effect on choice of food.

• Economic determinants such as cost, income, availability.

• Physical determinants such as access, education, skills (e.g. cooking) and time.

• Social determinants such as culture, family, peers and meal patterns.

• Psychological determinants such as mood, stress and guilt, attitudes, beliefs and knowledge about food.

FOOD CRAVINGS OR DESIRE: WHAT DOES IT REALLY MEANS?

“Tell me what you eat and I will tell you what you are”- Jean Anthelme Billat Savarin.

Food cravings are the way to fulfil the need of specific types of nutrient in our body. Food cravings mean that body is warning that something is out of balance. [8-10]

1. Craving Ice:  craving for the cold food or ice it might be a sign of anemia. The researchers hypothesized that chewing the ice might temporarily increase blood flow to the brain, counteracting the slowdown caused by iron deficiency.

2. Craving Chocolate:  According to the study of American chemical society, chocolate desire occurs when the person is under stress or depressed. The dark chocolate boosts the levels of serotonin and dopamine. Other than that, chocolate contains magnesium and the bromine, which helps reduce levels of stress hormone and promotes muscles relaxation. Also seen in pre-menstrual syndrome.

3. Craving sweet or sugar:  Indicates deficiency of magnesium, zinc and vitamin. Magnesium is used in the regulation of glucose, insulin, and the neurotransmitter dopamine; a deficiency can manifest in the form of intense sugar cravings, especially for chocolate. Zinc is needed for proper insulin and glucose utilization; thus it’s deficiency can also lead to sugar cravings.

4. Craving cheese:  Contain 1-tryptophan which improves mood and promotes relaxation. So, when a person desires for cheese it means body demands TLC. Taking it in reasonable portion helps to de-stress and feels better.

5. Craving soda: Reason for soda cravings is a calcium deficiency. The phosphoric acid in carbonated drinks can leach calcium and magnesium from bones, creating a vicious cycle of depletion and craving.

6. Craving fish: For fulfilling the demands of Omega-3 fatty acid. Our bodies don’t manufacture the fatty acid, so to get our daily requirement we have to eat it in foods like salmon and other fatty fish.

7. Craving water: It means body becomes dehydrated. But when a person craves water always it related to a deeper issue like diabetes.

8. Craving salt: Salt cravings can be a sign of a mineral deficiency, according to a study published in the Journal of Physiology and Behavior. Person who reported the highest amount of salt cravings were found to have the lowest levels of calcium, magnesium, and zinc. Cravings for salt can also be a need for silicon in the diet. Can also be an indicator for hypertension.

9. Craving salsa: Salsa means a spicy sauce made with tomatoes, onion and hot peppers that is commonly served with Mexican food. Hot salsas and spicy curries temporarily increase metabolism, making sweat more and thereby helping the person cool down. That’s why salsa or spicy cuisine are more desired by persons residing in warmer climates.

10. Craving bread, pasta and other carbs: A craving for foods high in carbohydrates means to increase consumption of nitrogen. To get more healthy nitrogen, replace the carbs with high protein foods like eggs, nuts, beans and chia seeds.

11. Craving …anything:   An intense craving for any food is often mistaken as hunger when in reality it may mean the person becomes dehydrated. Thirst is actually the last signal for dehydration. “We often misinterpret the signals our body is giving us,” explains Newhouse. “As a society, we are chronically dehydrated”.

12. Pica:  Pica is the persistent craving and compulsive eating of nonfood substance. DSM- 4 classifies it as a feeding and eating disorder of childhood. Most common type of pica are: Geophagia- eating earth, soil, clay; Pagophagia- eating ice and Amylophagia- eating starch.

Higher incidence of pica is associated with

• Pregnancy, due to anemia

• Developmental delay and mental retardation 

• Early childhood

• Autism

• Poor nutrition, low blood level of iron and another mineral.

• Certain cultural and religious tradition.

CERTAIN STATES MODIFIES CRAVING: [11,12]

There are certain physiological and pathological states which modify our food habits.

• Addison’s Disease- craving salty foods.

• Diabetes Mellitus- craving for sweets.

• Adrenal cortex disease – salt craving.

• Alcoholism- craving alcohol.

• Food cravings during pregnancy: chocolate cake, sour items or apples, and sometimes there is an urge to eat unusual food combinations or a type of food that you normally don’t like.

• Pre-Menstrual syndrome: craving for sugar, carbohydrates 

COMMON QUESTIONS GENERALLY ASKED DURING CASE TAKING RELATED TO DESIRE AND AVERSION OF FOOD AND DRINKS:

General symptoms are those which affect the whole body and are at higher rank than the particulars, which are only related to special organs. Desire and aversion of food are marked characteristic generals and one of the important components of totality of symptoms. Human body consists of will and understanding, and the symptoms of desire and aversion are related to the will part of the man. To obtain the symptoms related to Desire and Aversion of food and drinks, our master Hahnemann mentions some questions in aphorism 88 of Organon of Medicine: What kinds of food and drink are most relished? What are most repugnant to him? [13]

Similarly Dr. James Tyler Kent says “The desire and aversion often give the key to complex totality of symptoms”. In his book “What the Doctor Needs to Know in Order to Make a Successful prescription” he mentions the following: [14]Have you a craving for any special article of food? (not merely a desire, but a feeling that you must have it).

• Any aversion to any special article of food? Name the article in either case.

• Is the hunger or craving for food excessive?

• Have you no desire for food?

• Do you have hunger with aversion to eating?

• Do you eat without hunger?

• Does the food taste good?

• Is there any special food that disagrees?

• Do you desire solid or liquid food?

• Do you crave you don’t know what?

• Do you crave substantial food or dainties, candy, cakes, sweet things, sour things, etc., etc.?
• Are you very thirsty or thirst less?
• Do you crave any special drink?
• Do you wish hot or cold or ice-cold drinks?
• Do you use tea or coffee? How much?
• Do you use alcoholic or other liquors?
• Do you use much milk? Etc. 

• Master Hahnemann’s view: “The desire of the patient affected by an acute disease with regard to food and drinks is certainly chiefly for things that give palliative relief; they are however not strictly speaking of a medicinal character, and merely supply a short of want. The slight hindrances that the gratification of this desire, within moderate bounds, could oppose to the radical removal of the disease will be amply overcome and outweighed by the strength of the appropriate homoeopathic medicine and vital principle, which it has set free, and by the comfort that the patient has derived from the satisfaction of his craving”- ⸹263 OF ORGANON OF MEDICINE.  [13]

• Dr. Phyllis Speight: “The third grade of Generals relate to Desire and Aversions. There must be recent changes and must be distinct longing and loathing. For example, when a person states that he has never drunk beer, but since he felt unwell, he longs for a glass, then it is a reliable indication. But a mere like or dislike is of little value.” [15]
• Dr. D.M. Borland: “all the general symptoms are not equal value. They group under different heading according to their degree of importance. General symptoms which express physical desires and aversion are of the greatest importance. By physical desires and aversion, one tries to express first of all any sexual disturbances, and secondly any aversions to or cravings for any particular articles of food or drink”. [16]
• Dr. M.L. Dhawale: “Cravings (intense desire) and loathing (intense aversion) for certain types of food are again highly distinguishing marks.  They should be given due credit in the final stage of evaluation”. [17] 

MIASMATIC VIEWPOINT: [18-20]

THERAPEUTIC APPROACH: We have tried highlighting the desire, aversion and intolerance of some of the most common food items used in our day to day life so that this can give us a therapeutic hint about the individualized remedy which the patient might require for his treatment. They are as follows: [21-26]

REPERTORIAL APPROACH:

It is difficult to memorize all the foods and drinks desire aversion of all remedies. Some of repertory and their presentation of rubrics and where we can find the rubrics are as follows:

• In Kent’s Repertory, rubrics Desire & Aversion come under chapter Stomach. [27]

• In Boenninghausen’s Therapeutic Pocket Book, rubrics Desire & Aversion come under the chapter Hunger & Thirst. [28]

• In Synthesis Repertory, rubrics Desire & Aversion come under the chapter Generals. [29]

• In Murphy’s Repertory, rubrics Desire & Aversion come under the chapter Food. [30]

• In Boger- Boenninghausen’s Repertory, rubrics Desire & Aversion come under the chapter Appetite. [31]In Boericke’s Repertory, rubrics Desire & Aversion come under the chapter Stomach. [21]

• In WM.J. Guernsey’s A repertory of Desires and Aversions rubrics are present in the repertory part as A) Desire for B) Aversion to.[1]

A 17 years old male patient visited OPD 11 of Mahesh Bhattacharya Homoeopathic Medical College & Hospital on 5^th April 2021, presenting with small pustular painful swellings on face with slight itching for last one and half year. The itching is ameliorated by cold application. Past history gives information that he has suffered from chicken pox and jaundice at 6 and 13 years of age respectively. Familial history reveals mother had uterine fibroid and father is suffering from hypertension. The marked physical generals are desire for salty food, fish and bitter; having profuse perspiration with white stains; sun heat intolerance and thermal reaction being hot patient. The important mind symptoms were - introvert & prefer to stay alone. Diagnosis was made as Acne Vulgaris. Based on the above facts Natrum mur 200 / 2 doses was prescribed for the first two days to be taken at early morning empty stomach, followed by placebo. Follow-up was done on 19^th April 2021, having the features: itching and pain decreased no new eruption. Placebo was given again. Further on 10^th May 2021: Patient is much better than before, acne decreased. 

Figure Image is Available in PDF Format

Every Homoeopathic medicine is selected on the basis of Totality of symptoms with strict individualization. To form the totality, mental general symptoms, physical general and then particular symptoms are to be taken into consideration as per hierarchy or as per the intensity and frequency of symptoms. Among the physical general symptoms, the symptoms of desire and aversion of food & drinks get the distinguished mark as paid by many authors. So, Totality of Symptoms on strict principles to get the individualized person and his remedy is the sole basis of prescription. 

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the National Institute of Homoeopathy, Kolkata, India

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