The Dangers of Sushi: Paralysis and Death from Puffer Fish (Fugu) and Other Raw Fish Food-borne Illnesses

People who love sushi and sashimi say these Far Eastern delicacies are to die for. Although they don’t mean that literally, consuming some raw fish truly is dangerous.

The most notorious and celebrated of the Japanese Sashimi selections is the Pufferfish, called Fugu in Japan. The flesh of the puffer fish can be lethal if prepared incorrectly, and only specially licensed chefs are allowed to sell it. Even so, a number of people die every year from eating it. Often, they are untrained enthusiasts who catch, prepare, and consume their own pufferfish and accidentally kill themselves. The poison paralyzes the person, who stays fully conscious before dying from asphyxiation.

Most Japanese cities have several Fugu restaurants, which are usually clustered together because regulations once placed limits on where they could operate. Although closely monitored, not all Fugu restaurants are equal. People seek out the best quality Fugu, which supposedly still has non-lethal amounts of the poison remaining in its flesh, and produces a tingling sensation on the tongue.

Although fugu remains an almost exclusively Japanese delicacy, sushi ranks among the most wildly popular exports from Japan. If you’ve hesitated to try it, you may have good reason. Raw fish can be infected with parasites, and every year there are hundreds of cases of illness caused by them. In the United States, however, you are more likely to become ill from eating cooked beef or chicken than raw fish. That’s because commercial fish intended for raw consumption must be frozen for at least 72 hours (that’s 3 days) at -4 degrees Fahrenheit, in order to kill dangerous parasites and their larvae.

Yuck, it’s a wormy problem! If you encounter a bad piece of sushi, the most common infection is the tapeworm, a relatively benign parasite that many people don’t realize they have until they pass it. Tapeworms, as well as flukes or flatworms, can cause abdominal cramps, diarrhea, nausea, fatigue, and weight loss, but they are usually easy to treat with anthelmintics.

Of much greater concern is the roundworm, also known as anisakis, which can bore into the lining of a person’s stomach or intestines and cause severe abdominal inflammation and pain, often within an hour of eating. Surgery may be required to remove it. The worm can taint the flesh of a fish with toxins, and eating it could cause a severe allergic reaction.

A Food and Drug Administration study of Seattle area restaurants found that one in 10 samples of salmon contain roundworm. Fortunately, virtually all were dead because the fish had been flash frozen. As in the United States, most countries now require that all types of commercial fish intended for raw consumption be deep-frozen.

However, researchers with California Health Services continue to place raw fresh fish on its list of risky foods that can carry infection causing viruses, bacteria, and parasites. Other foods on the list include rare-cooked ground beef, uncooked egg yolks, unpasteurized milk, and alfalfa sprouts. According to CHS, properly prepared, handled, and frozen sushi-grade fish is safer than other raw fish, but it is still not as safe as cooked fish.

The bottom line is it that it is safest to eat cooked seafood. But if you can’t resist Sushi, make sure it is prepared by trained, experienced chefs who know what they’re doing. The FDA suspect most illness is caused by the consumption of homemade sushi. Satiate your sushi cravings at reputable restaurants and ask whether the fish has been deep frozen. The safest bet is to order sushi dishes made with cooked fish, such as California rolls. And if you go to Japan, get your foo-goo fix only from a reliable dealer.

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