Teljemo, Hi and welcome! I hope it's not too cold right now in Sweden. Been a rather tepid winter in Norway.

Acetylcholine (ACh) is brought into the neuromuscular junction via the nerves to make muscles strong. Then acetylcholinesterase (AChE) mops up what is left over so there isn't a buildup of it.

Mestinon is a "cholinesterase inhibitor" and keeps acetylcholinesterase from "eating up" acetylcholine. That way, we can use our "muscle gas" longer than if we didn't take Mestinon.

Some foods are cholinesterase inhibitors, too, but their strength is of an unknown degree. Yes, garlic is one of those foods. The nightshades, too. If you can eat them without a problem, then just keep eating them!

When they might become an issue is if you are on high doses of Mestinon. They could possibly cause you to have a cholinergic crisis, where you have too much acetylcholine! It's the opposite of a myasthenic crisis, where you don't have enough acetylcholine. Both have similar symptoms, so it's not always easy to tell unless you stop taking Mestinon. You should do that without being under the direction of a doctor! Or you could see if you're better or worse when the Mestinon runs out, which is about 2-1/2 hours after you take it.

There are drugs that do the opposite of Mestinon, such as Atropine. Eye drops they give at an eye appt. contain Atropine, so that might make your MG worse (it does mine!). Quinine in tonic water, as you guys have already talked about, does that, too.

You can find a multitude of articles such as this that discuss plants and foods which are cholinesterase inhibitors.

http://www.ncbi.nlm.nih.gov/pubmed/22510493

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877586/

http://www.atsdr.cdc.gov/csem/csem.asp?csem=11&po=15

Things such as DEET, organophosphates, etc. are not good for MGers. Buckthorn is a plant that is a cholinesterase inhibitor, and often grows wild if unchecked.

A food diary is a very good idea, if you believe you are having issues with some foods.

The only reason you would get ten different answers from MG patients on this topic is not due to the basic science of drugs and foods and their cholinergic effects on a patient with MG. It's due to how their MG is doing and how many drugs/dose of drugs that they're on. If you get too high of a "load" of cholinesterase inhibitors, then you could go into a cholinergic crisis. If you aren't having enough, some of those foods might help (i.e., caffeine, which is a CI, too).

It's always a good idea to try one thing at a time, too, if you want to see if a cup of coffee helps your MG. Then you can know which thing is making you better or worse!!!

Alcohol is a tricky thing. You might not feel the effects of it right away. It can cause you to not be able to breathe while you're sleeping (muscles become weaker while sleeping). Or it can have effects in a day or two. So be careful with how much you drink.

BTW, did your docs say to take Calcium and Vitamin D while on Pred? Did they say that it would be a good idea to have some omega 3's (good prostaglandins) while on the anti-prostaglandin Pred?!

Annie