MOST people have come to know ackee or Blighia Sapida in association with cuisine, namely our ‘national’ dish. It is of nutritional value as it is a high source of fat, carbohydrates and essential elements such as zinc, calcium, potassium, and magnesium.

But with a recent report of 35 incidences of ackee poisoning, within the last month and a half, the importance of proper preparation cannot be more emphasised. Ackee poisoning dons other names such as the Jamaican Vomiting Sickness and a form of Toxic Hypoglycaemic Syndrome. Jamaica has seen ackee Poisoning since 1875.

Ackee Poisoning (Clinical features)

* Vomiting

* Dizziness

* Fatigue

* Fainting

* Comatose state, which may lead to death

* Persons have been known to present with jaundice

Mechanism of poisoning

* The ackee fruit contains two amino acids: Hypoglycin A and Hpoglycin B

* Hypoglycin B is the less toxic of the two amino acids and is found predominantly in the seed.

* Hypoglycin A is very toxic and is found in both the seed and aril (fleshy part which we eat). This amino acid is generally referred to as just hypoglycin.

* It is important to note, however, that it is not the hypoglycin that causes the damage, but its metabolite: when hypoglycin is absorbed into the body it is metabolised to the ester methylenecyclopropyl acetic acid-CoA (MCPA-CoA) in the liver.

* Among other things, MCPA-CoA hinders gluconeogenesis, the process by which glucose is produced from non-carbohydrate substances such as amino acids.

* This process is important in the period between meals, when we are not taking in sugar. As a result the symptoms of poisoning present generally within two to six hours of ingestion of the ill-prepared ackee and death within approximately 12.5 hours if not treated.

* By hindering gluconeogenesis there is a resultant hypoglycaemia which means a low sugar level in the blood.

* The brain survives almost solely on glucose. The aforementioned symptoms are due to brain starvation of glucose and the direct effect of hypoglycaemia on the body, making it important that persons experiencing these symptoms drink something sweet on their way to a health facility to increase their blood sugar levels.

Causes

* Consumption of the unripe ackee. Why?

The unripe aril of the ackee is 20 times more toxic than the aril of the ripe ackee. Therefore one should only pick and prepare to cook those which have fully opened.

* Reuse of water in which the ackee has been boiled, especially the unripe ackee. Why? During cooking/boiling much of the toxic hypoglycin moves from the fruit into the water.

* The red membrane on the aril close to the seed was not removed. Why?

This part of the aril is always poisonous.

* Diabetics on their medication are more susceptible and should meticulously ensure that their ackee is prepared properly.

— Contributed by Adrian Coore and Kerone Wint, medical science students at the University of the West Indies, Mona Campus