David L. Katz, MD
Photo: Mackenzie Stroh
Q: After eating sushi in Hawaii, I got a type of food poisoning called ciguatera. Three years later, I'm still suffering side effects, including nerve damage. My doctors have severely limited my diet in attempts to treat me, but nothing is working. How common is this type of food poisoning, and is there any way to get rid of it?
— Chelsea Brecht, Minneapolis, Minnesota

A: In some tropical areas, including coastal regions of the United States like Florida, ocean algae generate toxins that make their way through the marine food chain, ultimately accumulating in the flesh of fish such as sea bass, mackerel, grouper, and red snapper. Eating these fish can result in ciguatera—poisoning by ciguatoxins. It's a fairly common illness: Roughly 50,000 cases are reported each year, and most experts believe the incidence is actually much higher since the diagnosis is often missed and many cases are never reported.

Within hours of eating contaminated fish, a person can experience classic food poisoning symptoms (nausea, vomiting, diarrhea) but may also suffer neurological problems such as numbness, tingling, joint pain, muscle pain, dizziness, the sense that one's teeth are loose and about to fall out, and the inability to distinguish between hot and cold. Some victims experience breathing troubles, low blood pressure, and slowed heart rate, which can turn lethal.

Usually, the symptoms resolve within hours or days. But in a small percentage of cases, the neurological troubles persist—or recur periodically—for months or even years. This may be because the body stores ciguatoxins in fat tissue, and over time they slowly leach out, attacking nerve synapses.

No definitive medical treatment exists for the long-lasting neurological symptoms of ciguatera. There are reports that some patients find relief in avoiding fish, seafood, alcohol, nuts, and nut oils, though it sounds like limiting your diet isn't doing the trick. Most people eventually recover fully, which in your case may mean when residual toxin is fully gone from your body. Given that conventional medicine isn't providing much relief, consider consulting with a complementary medicine physician or naturopath. These doctors are familiar with many types of alternative treatments and might suggest acupuncture or other creative ways to help alleviate your symptoms.

As a reminder, always consult your doctor for medical advice and treatment before starting any program.

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