Ciguatera Poisoning & Chronic Fatigue Syndrome

Image Credit: Pen Waggener / Flickr. This image has been modified.

Chronic Fatigue Syndrome & Fish Food Poisoning

Ciguatera is one of the most common forms of food poisoning, which occurs after the consumption of fish contaminated with neurotoxins produced by certain microalgae that build up the food chain. Just a few bites can be sufficient to induce the condition. Disturbingly, affected fish looks, smells, and tastes normal, and ciguatoxins are resistant to all forms of cooking. So, there is no straightforward method to predict whether a seafood meal can turn into a ciguatera nightmare.

It literally can cause nightmares; about one in six may experience signs of hallucinatory poisoning: lack of coordination, hallucinations, depression, and nightmares. Most suffer some kind of neurological symptoms, such as tingling, numbness, and a burning cold sensation. Sometimes, a reversal of temperature sensation occurs, where cold objects feel hot and vice versa. For instance, ciguatera sufferers have reported that a refreshing dive in the ocean actually caused burning pain, or that drinking cool beer felt like too hot coffee.

The toxin may also be apparently sexually transmitted, or as one of my favorite public health bloggers put it, “when hot sex turns cold and painful, blame it on dinner.”

As seen in my video Ciguatera Poisoning & Chronic Fatigue Syndrome, the symptoms can persist for months or even years. Ongoing research has shown that people with chronic fatigue syndrome may actually be suffering the long-term effects of this fish food poisoning or a condition called polymyositis, which causes diffuse muscle aches, pains, and inflammation. Some individuals intoxicated by fish consumption 25 years previously experience a recurrence of the main neurological disturbances during periods of overwork, fatigue, or stress. You can still find the toxins stuck in your body decades later.

Recent outbreaks in New York City have drawn attention to the problem. For example, a man ate grouper at a Manhattan restaurant and went from swimming two miles a day to having difficulty walking that lasted for months. But these aren’t just rare anecdotes. Ciguatera fish poisoning affects an estimated 15,000 Americans every year, causing hundreds of hospitalizations and even a few deaths. Because the toxins are colorless, odorless, tasteless, and not destroyed by cooking, CDC scientists suggest “education aimed at the prevention of seafood intoxication by avoidance of high-risk fish altogether.”

The AMA put out a similar advisory, suggesting that the only way to prevent it is to avoid eating fish like red snapper or grouper, but the problem is that a third of fish sold in the United States is mislabeled; so, we don’t know what we’re getting. Some suggest first feeding a portion of the fish meal to a cat, treating them like a court tester, and if they’re okay six hours later, we can dig in — but this was considered inhumane. But if it’s inhumane to feed it to your cat, how is it not inhumane to feed it to other members of the family?

Many more are killed by more conventional food poisoning bugs (Chicken Salmonella Thanks to Meat Industry Lawsuit), but how scary that you can get these toxins stuck in you and ruin your life? Reminds me of my Amnesic Seafood Poisoning video.

Other neurotoxin videos include Preventing Parkinson’s Disease With Diet and Essential Tremor and Diet.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations—2013: Uprooting the Leading Causes of DeathMore Than an Apple a Day2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

49 responses to “Chronic Fatigue Syndrome & Fish Food Poisoning

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  1. So, if the fish are not mislabeled, this only occurs in snapper and grouper? Why would other fish be
    free of this threat? What is it about these 2 fish, and, say, why does it not affect wild salmon or sardines?

  2. Another reason to stay away from warm water fish, in addition to the fact that they are very low in Omega-3 EFAs. Otherwise cold water fish like mackerel and sardines are an essential part of a healthy diet, since many people are unable genetically to convert ALAs into EPA and DHA.

    1. rpabate: re: “…many people are unable genetically to convert ALAs into EPA and DHA.” I’m sure there are some people that have this problem since every imaginable defect exists in someone, somewhere. But I’ve never heard of this problem before, and I’ve definitely never heard that “many people” have this problem. Do you have a study to back up this claim? I am interested. Thanks.

      1. An interesting interview of a “omega 3 expert” Nils Hoem.

        EPA and DHA Are Crucial for Health

        DHA is especially important, as it is a component of every cell in your body, and it’s particularly crucial for your brain. More than 90 percent of the omega-3 fat found in brain tissue is DHA, and the development of a normal brain in a fetus is dependent on the availability of DHA. All other omega-3 fats are found only in trace amounts in your brain, including ALA, regardless of how much ALA you consume.2

        There are actually specific transporters for long-chained omega-3s in your blood-brain barrier, the placenta (in pregnant women), and likely also in your liver, which transport these molecules in a very precise way into the cell membranes where they belong. No such transporters exist for the short-chained omega-3s.

        So please, don’t make the mistake of confusing plant-based (short-chained) and animal-based (long-chained) omega-3, as doing so could have severe health consequences. You absolutely need animal-based omega-3 (DHA and EPA), and you simply cannot obtain the same benefits from plant-based sources.

        I’m not vilifying plant-based omega-3 fats. You do need ALA; you just don’t need an excess of it. And don’t think you convert that ALA to EPA and DHA, because you just can’t. That said, ALA is a very healthy fat that serves its own useful purpose.

        1. At the end the “expert” does say you could probably get some benefit from eating some algae supplement.

          If you’re an unwavering vegetarian and refuse to eat either fish or krill, you could potentially obtain some EPA and DHA from eating algae, although there are open questions about algae as a clean, healthy source.

          1. Gary: re: questions about clean source
            FYI: The DHA/EPA algae derived supplements all come from sterile/clean factories. There is no contamination.

        2. Dr. Greger actually has a video on this topic. It’s a misnomer to call them “animal-based omega-3’s” because the fish typically get their omegas from algae or from the fish that eat algae. It isn’t difficult to get “animal-based omega-3’s” like DHA and EPA from plant-based sources/supplements as long as you don’t mind the source being algae ☺️

        3. Nils Hoem is an expert but he is also the VP (and Chief Scientist) of a Norwegian company that sells krill products. That may be why he incorrectly writes “don’t think you convert that ALA to EPA and DHA, because you just can’t.” Studies show that people can and do.

          However, a 2006 study observed

          “our results support the concept presented by Sinclair et al (2) that a reduction in dietary LA together with an increase in ALA intake would be the most appropriate way to enhance EPA and DHA synthesis from their parent fatty acid ALA. However, it is also clear that this approach will not lead to substantial increases in plasma phospholipid DHA contents as can be obtained through a moderate consumption of fish or marine oils (1). This agrees with findings in vegetarians and vegans who have lower proportions of plasma EPA and DHA (26).”

          This suggests that vegetarians probably do need to supplement. However, krill oil like fish oil contains persistent organic pollutants and algal oils may therefore be the safest option.

          1. I thought their was something “fishy” about Nils Hoem because he acted like he had never heard of algae oil. A top omega 3 scientist should know about DHA and EPA from algae oil and that it is just as effective as fish oil.

      2. Here is the link:
        Years ago when I converted to a plant only diet I started to suffer from serious heart arrhythmia. After doing some research, I discovered that it may be due to insufficient DHA and EPA from my diet. Once I started consuming fish high in N-3 EFA they eventually disappeared. I also supplement with both fish and krill oils. I also consume moderate amounts of shell fish. Clams are high in iron and oysters high in zinc. I enjoy both in addition to mussels. I eventually had my blood tested for the ratio of N-6 to N-3 and it was fantastic, around a 2:1 ratio, which is very healthy. Whenever I eat fish, mostly wild salmon with a few mussels or clams thrown in, it is always poached in a mixture rich in vegetables — turmeric, garlic, oregano, black pepper, oyster mushrooms, lots of Italian parsley, serranno (spicy) pepper, tomato paste and diced tomatoes — plus EV unfiltered olive oil and white wine.

        If being a strict vegetarian makes you happy, by all means go for it. I did not do well on an all plant diet, but I was on to why most farm raised meat and fish were unhealthy. I made my chose to include wild caught, cold water fish in my diet and I am very happy I did. By-the-way, I purchased Dr. Greger’s book and also sent copies to my two daughters. I think we all owe it to ourselves to be as knowledgable as possible about matter of importance. Just as I went from being a strict vegetarian to a pesca vegetarian based upon research, I also went from being a global warming alarmist to a global warming skeptic after also doing considerable research.

        An interesting fact about Dr. Gerger book “How Not to Die”. I would guess that one of the most frequently used words in the book was “may”. I guess his lawyer had something to do with this.

        1. rpabate: Thanks for the reply. The link you provided is just an article on a website that sells fish…

          But the article references a study, which I found: I did not understand the abstract enough to be able to see if it is really saying that a large number of humans actually can’t convert ALA to DHA and EPA or if it is just harder in some humans over others. As I showed in my post I referenced earlier, other studies show that human bodies not only can do the conversion, but that the conversion is more efficient in people who do not eat fish.
          It’s interesting that you chose to eat fish rather than just consume a safe algae-based DHA/EPA supplement and thus avoid all the negatives that come with fish: contaminants, animal protein, cholesterol, saturated fat, etc. That said, I understand that you are happy with your diet. Good luck.

          1. I am no expert but my reading of the article suggests that it is saying that humans are in fact very efficient synthesisers of PUFAs. However, it comments that for many people in Western countries it is this very efficiency that may be the problem in so far as it accelerates omega 6 production.

            “Regarding the present diet in the Western world, the advantage of having a faster biosynthesis of LC-PUFAs for carriers of haplotype D might have turned into a disadvantage. Because haplotype D increases the biosynthesis of both omega-3 and omega-6 LC-PUFAs, high intake of omega-6 LC-PUFAs augments the amount of AA and thereby the synthesis of arachidonic-acid-derived proinflammatory eicosanoids, which are associated with increased risk of atherosclerotic vascular damage.62 Thus, we hypothesize that the acquisition of a FADS haplotype—which might have been beneficial when food sources rich in the essential LC-PUFAs were in limited supply and when humans had to rely on vegetable oils containing precursors of these fatty acids—would now act as a thrifty genotype and represent a risk factor for lifestyle-related diseases, such as coronary artery disease.18”

            Poorly planned vegetarian diets are too high in omega 6s, especially those including extracted plant oils. Dr G has been saying this for many years of course and I will mention (yet again) my favourite video – that of his presentation back in 2003. The best solution is probably not fish consumption but a well-planned WFPB that delivers a good omega 3/6 balance.

              1. My pleasure. This is essentially the same issue (the details are different of course) as that kerfuffle a while back about the Indian “vegetarian gene” and increased risk of cardiovascular disease and cancer.

                The “risk” of course is essentially only to people who eat highly processed vegetarian foods and use oils for cooking, salads etc. WFPB vegetarians don’t really have that risk, especially when they follow the recommendations of people like Dr G, Jack Norris etc.

                We have always known that highly processed and refined plant foods are just as “risky” as animal foods.

            1. Bel, I think you are asking the same question here as you did in the other post. If so, please see my other reply. If this is a different question, please clarify. :-) Thanks.

        2. Hi rpabath
          The reason we use “may” when talking about research and science is because another research article may come along tomorrow that shows something slightly different. it is today’s best information. He isn’t afraid of being sued. All scientists talk that way.

          1. It’s probably also true that there could be research already done that may be in conflict. My comment was not a criticism. I applaud Dr. Greger for using “may” as it indicates some uncertainty, which, when discussing what is best for the human body with all its complexity, is completely justified.

    2. The body can convert ALA into EPA and DHA in most cases but it requires a huge amount of ALA because the conversion process is inefficient. So in essence what you stated is almost right.

      The body can convert ALA into EPA and DHA. ALA is efficiently converted to EPA, but it may require large amounts of ALA to produce optimal amounts of DHA. A small amount of recent evidence has raised a concern that large amounts of ALA could be harmful to the eyes over the long term.

      1. Freestyle1: You don’t need very much DHA or EPA. So, saying it requires a “huge” amount of ALA could be misleading. According to sources I have seen, women need 1.1 g omega 3 and men need 1.6 g omega 3 – about 1/4 to 1/3 teaspoon.
        It is also interesting to note that humans which do not eat fish are much more efficient at converting ALA to DHA. Dr. Greger does think there may be good reason for vegans to directly consume a safe source of DHA/EPA (ie, a supplement from algae). There is a series of videos on this site which cover that. However, I think the information below (from a previous post of mine) is also relevant.
        The main points are:
        1) The bodies of vegan people do a better job of converting ALA to DHA. So, the question is, even if the conversation rate is low, can our bodies convert enough to make us healthy? We don’t need very much:
        2) Studies of vegan people show DHA levels to be high compared to other groups. Other studies show vegan bodies to be relatively low, but in those cases there is no apparent harm from those levels. So, the problem may be in the assumption that the DHA levels are low.

        In regards to ALA conversions, This recent study showed that the conversion rate in Vegans is 2x that of a fish-eater.

        “Comparison of the PLLC n23 PUFAs:DALA ratio between dietary-habit groups showed that it was 209% higher in vegan men and 184% higher in vegan women than in fish-eaters, was 14% higher in vegetarian men and 6% higher in vegetarian women than in fish-eaters, and was 17% and 18% higher in male and female meat-eaters, respectively, than in fish-eaters This suggests that the statistically estimated conversion may be higher in non-fish-eaters than in fish-eaters.”

        In addition, another study showed that despise this “theoretical” low conversion rate, there is no evidence of any harm so, the problem may not be in the conversion rate, but in the assumption that it is low.

        Prostaglandins Leukot Essent Fatty Acids. 2009 Jun 3.

        “There is no evidence of adverse effects on health or cognitive function with lower DHA intake in vegetarians.

        In the absence of convincing evidence for the deleterious effects resulting from the lack of DHA from the diet of vegetarians, it must be concluded that needs for omega-3 fatty acids can be met by dietary ALA. ”

        They also noted the importance of limiting excess omega 6’s, especially in vegans/vegetarians.

        American Journal of Clinical Nutrition. November 2010, Vol 92, Number 5, Pages 1040-1051. The vegans in the study actually had highest levels of DHA (which most sources say it’s harder for the body to convert ALA into DHA, than it is to convert ALA into EPA) compared to the fish eaters, non-fish-eating meat-eaters, and vegetarians. This was despite the fact that they consumed less omega 3s. (Stephanie also found an article that summarizes the study:

        1. The following comes from a vegan site that I listed above. Your choice.

          It appears that vegetarians meet about 50 to 60% of the daily ALA recommendations without special diet planning.

          Vegans and vegetarians have been shown in many studies to have lower levels of long chain omega-3 fatty acids (EPA and DHA) than meat eaters. Table 4 shows the results of some of these studies. The general trend is that lacto-ovo vegetarians and vegans have lower levels of EPA and DHA in their blood.

          One exception is the 2010 UK study in which vegan women had, on average, higher DHA levels than even the fish-eaters. There were only 5 vegan women making the finding unlikely to be statistically significant; the average DHA level was 286 µmol/l with a standard deviation of 211 µmol/l. That means that one or two of the vegan women had very high levels of DHA but some had very low. The researchers didn’t assess how long the vegans had been following their diet.

          Lower blood levels of EPA and, especially, DHA in vegetarians doesn’t necessarily mean that they have lower levels of EPA or DHA in other tissues, but it is something to be careful about until more is known.

          Effects of Low EPA and DHA on Vegetarians

          One of the main things that long chain omega-3 fatty acids do, particularly EPA, is reduce blood clotting which protects against heart attacks. There have been some differences noted in blood clotting between vegetarians and meat-eaters.

          A 1999 Chile study (18) found that vegetarians had significantly more platelets (242,000 per ul) than non-vegetarians (211,000 per ul) and a shorter bleeding time (4.5 vs. 7.3 min).

          In a follow-up 2000 Chile study (4), vegetarians were given 700 mg EPA and 700 mg DHA for 8 weeks. EPA went from .2 to 1.8% and DHA went from 1.1 to 3.0%. Some clotting factors did change, but bleeding time remained higher at 5 1/2 minutes.

          In a 1992 UK study (16), only one of eight platelet aggregation parameters in the men (but not the women) was different from the non-vegetarians. Bleeding times were similar.

          Thus, of two studies that looked at these factors, vegetarians were doing worse than meat-eaters in one, but were basically the same in the other.

          In terms of depression and cognition, there has been no research on omega-3s and vegetarians, but Joel Fuhrman, MD, has a private practice seeing many long-term vegans and has observed some older vegan men with very low DHA levels and cognitive problems, so there is reason to be prudent regarding DHA in older vegans, especially men (link).

          To bolster this theory, here is an excerpt from a paper on DHA and Alzheimer’s Disease:

          Docosahexaenoic acid (DHA), a dietary essential omega-3 fatty acid concentrated in membrane phospholipids at synapses and in retinal photoreceptors is decreased in [the Alzheimer disease] brain. This deficiency may be due to enhanced free radical–mediated lipid peroxidation, decreased dietary intake, and/or impaired liver DHA shuttling to the brain. Decreased DHA serum content correlates with cognitive impairment. Moreover, epidemiologic studies suggest neuroprotective consequences of diets enriched in omega-3 fatty acids (37).

          1. WFPBRunner: I can’t say I have a “favorite” brand. That’s the short answer.

            Here’s the long if you want it: I bought an algae DHA/EPA oil supplement at one point. It is liquid/drops, and I think I bought a brand that someone else recommended. But I’m soooo terrible about taking supplements, that I don’t think I ever actually tried it (yet). I’m better with pills like B12 which can sit on the counter and stare me in the face every day. The DHA/EPA (and for that matter, the vitamin D I got) sits in my fridge. I forget I have it for weeks at a time.
            (Side note: I’ll tell you one good benefit of my moderating here. Every time someone mentions B12, I run and take a pill as I’ve usually forgotten in too long. I think I owe you for one of my recent pill takings. :-) )
            I could write myself a note or something until I got in the habit of taking the supplements from the fridge, but despite Dr. Greger’s very good video series, I’m not 100% convinced of the need for DHA supplementation. Probably my real reservation about the DHA/EPA one is that I’m squeamish about putting so much oil in my mouth. I think it says something like 14 drops… ewwww I could put it on food, but I don’t consume anything consistently enough for that idea to work. Then I decided I should test myself before worrying. Then I never got in a great hurry to do the test. :-O (Sometimes I greatly disappoint myself.)
            Please note that I don’t think anyone should follow my lead here. I’m just answering your question. I’m not recommending anyone take or forego an algae-based DHA supplement. I think there is enough evidence to take that supplement on the principle of abundance of a caution and all that–especially in light of not having any tests. I’m just being honest about my own lack of following good advice.
            If you want me to look up in my fridge what brand of DHA/EPA I got, I’d be happy to do that when I get home. Just let me know.

          1. Bel: You want to get one that is made from algae. Other than that, it really doesn’t matter as they all come from the same few factories. They just slap different brand names on the bottle. (This is according to another poster here who did some research on this some time ago.)
            Some factors you may want to consider are: Is the supplement in a pill shape or drops? Pick the one that you prefer. Also, check out cost. And finally, some people may be concerned about other added ingredients, such as what the shell of the pill is made from or what other ingredients are added to the oil. As near as I can tell, those “other ingredients” do not make a difference in terms of the effectiveness of the supplement. So, if you don’t care, then just get what works best for you. If you prefer not to eat gelatin/animal proteins, you might stay away from the pills.
            I can’t remember who, but one participant on this site recommended the DEVA brand. Here’s what I ended up purchasing: On the other hand, I have a relative who likes to get algae-based DHA/EPA pills, but can’t swallow them. So, she pulls out a pill, pokes the point of a sharp knife through the skin of one side and then squeezes it into her mouth. Because the oil is lemon flavored, she doesn’t think it tastes bad.
            I hope this post gave you some confidence to buy a supplement that will work for you.

      2. Then why levels of EPA/DHA in people who don’t eat fish are essentially the same? It appears the body will adjust and optimize this conversion if you don’t eat fish.



        There’s absolutely no good reasons to consume fish and expose yourself to these toxins and large amounts of saturated fats.

        1. Not quite according to the vegan web site.

          he following comes from the vegan web site:

          In terms of depression and cognition, there has been no research on omega-3s and vegetarians, but Joel Fuhrman, MD, has a private practice seeing many long-term vegans and has observed some older vegan men with very low DHA levels and cognitive problems, so there is reason to be prudent regarding DHA in older vegans, especially men (link).

          To bolster this theory, here is an excerpt from a paper on DHA and Alzheimer’s Disease:

          Docosahexaenoic acid (DHA), a dietary essential omega-3 fatty acid concentrated in membrane phospholipids at synapses and in retinal photoreceptors is decreased in [the Alzheimer disease] brain. This deficiency may be due to enhanced free radical–mediated lipid peroxidation, decreased dietary intake, and/or impaired liver DHA shuttling to the brain. Decreased DHA serum content correlates with cognitive impairment. Moreover, epidemiologic studies suggest neuroprotective consequences of diets enriched in omega-3 fatty acids (37).

    3. how often do you eat fish? Are you concerned about high levels of PCB’s in both wild salmon and sardines? Sardines also known to contain high levels of cadmium.

      1. I eat fish 3 to 4 times a week. The fish are mostly wild Alaskan salmon or black cod (sable) also from Alaska. Both are very high in Omega-3 PUFA. I eat shellfish less often, but they are a good source of some essential minerals. I eat NO PROCESSED FOODS, NO SUGAR, other than amounts found naturally in whole foods, and NO SIMPLE CARBS. I aim for a carb to fiber ratio of between 5:1 and 10:1. I supplement with fresh, unrefined flax or hemp oils, in addition to fish and krill oil tablets, and snack on seeds (chia, hemp and pumpkin) and nuts (walnuts and pecans) all of which I store in the freezer to maintain freshness. I add flax powder (high in ALA and also stored in the freezer) to my morning oatmeal along with one serving of prunes and one quarter teaspoon each of cinnamon and clove powder. I currently consume no land animal protein, dairy or eggs. I also consume large amounts of green leafy vegetables (kale, broccoli, dandelion, spinach, chard and beet greens) dressed with EV unfiltered olive oil and lemon juice (which is supposedly good for liver detox). Because I hate wasting food and am single, I generally eat the entire bunch of these greens at one time. I also eat a lot of salad dressed with olive oil and either balsamic or raspberry vinegar.

        So how does this diet show up in my blood test results? My latest test result: TC 172, TG 58, LDL 103 and HDL 56. I take no statin. High sensitivity CRP <0.2 mg/L. No inflammation, which is a marker for many degenerative diseases. As for my N-6:N-3 ratio, I use the Holman Omega-3 test which can be ordered on line and the blood gathered at home and mailed in. My N-6:N-3 ratio is 2.3:1 and AA:EPA ratio 1.3:1. The target for both is <5:1 and the typical U.S. control is 8.1:1 and 18.3:1, respectively. My N-3 as a percent of HUFA was 63%; the U.S. average is 24% and optimal is anything greater than 50%.

        Although I am always tweeking my supplements and diet to improve these numbers, I am perfectly happy with these result. At age 76, I do 30 minutes of interval training and 60+ minutes of weight lifting 5 days a week. No one has ever guessed correctly my age. One lady even thought I was in my forties, but maybe she was trying to flatter me because she was trying to sell me her super greens powder.

        1. Thanks! I am surprised though, why no fruit? Do you find it harmful to yourself, health-wise, maybe even harmful for most people? I assume this is what you mean by “simple carbs”, no?

          How about corn, brown rice…..occasional?

  3. I’m sorry you mentioned feeding it to a cat to “test” it…. that’s horrible…. PLEASE humans, DON’T DO THIS,..they have enough human horrors to contend with! They’re just trying to live their lives just as we are!

  4. Around 4 yrs ago I was down on a couch for 9 months w/ what my GP finally diagnosed, after numerous tests, as chronic fatigue syndrome. It eventually went away, but I must say that prior to and during my bout w/ CFS, I was consuming more fish than I ever had during my life. I had always wondered what caused CFS. Two years ago I went vegan, and don’t consume added fat. I feel better than I have in years, and am off blood pressure meds after 15 yrs. I so love and look forward to Dr. Greger’s posts and videos.

  5. What is the proposed mechanism for the supposed years-long duration of the effects of this intoxication? And how does anyone know that the reported problems are definitely due to it?

    1. Possible mechanisms and duration of symptoms, as well as other matters to do with cigatuera, are discussed in this 35 page article from 2000. It is worth a read if you have an interest in this topic.

      As for your second question, I’d suggest reading the article above and then following up the references to get a better idea of how reliable those reports are.

  6. I don’t get the argument that feeding your cat (and why not your dog?) the fish to test it out for your family is LESS inhumane. What’s with the hierarchy? We’re not in survival mode in this country – it’s a convenient fallback to pretend we are when things get inconvenient. It’s inhumane to use a companion animal as living Petrie dish. If you’re afraid of being poisoned by fish, it’s simple, DON’T EAT FISH.

    1. I do not think that there are any as yet. Diagnosis is usually done via identification of symptoms and recent history of fish consumption. There are some tests available, however, to detect affected fish. A journal article from 2008 which summarises what is known about cigatuera poisoning may be helpful.’

      This Australian leaflet is shorter and may also be helpful

  7. Today is 3½ years since I undertook the process of beginning a new lifestyle that has brought nothing but success. I wrote to you two years ago about my transformation from diabetic to no diabetes at all, the elimination of all pharmaceuticals from my life and the introduction of the foods and spices et al that you have suggested. I am going on 72 years of age, going strong, riding a bike, doing weights and generally having a good life. Thanks again for all you do, Doctor. You are a boon to those of us who know that something was wrong and you showed us how to fix it.

  8. Hello! I was diagnosed with Chronic Fatigue Syndrome/ ME two years ago – after being a very healthy, extremely active rock climber, hiker, runner.

    Thankfully The severe symptoms of being unable to walk went away after several months, but my exercise is still very limited. Switching to a WFPB no oil diet, I have gotten up to being able to power-walk 3 miles almost every morning!! But any more than that seems to lay me out for several days.

    I have seen the video on chocolate and chronic fatigue, and also this one here. Have you ever heard of Dr John K Chia’s Research? He suspects that there may be a non-polio enterovirus link such as Coxsackie and Echovirus. His clinic was right by my work, so I got to see him and my blood work was positive for Coxsackie B5 and Echovirus 6. Normally those viruses were barely more than a common cold, but he found that often people who have a low Igg (immunoglobulin type G) of any of the four types were more susceptible to having a long term viral infection of enteroviruses. I also had a very very low level of one of my igg types.

    Unfortunately, there isn’t much that could be done except take a supplement that costs $45 for 90 pills, aimed at increasing immune function.

    For a very summarized question that maybe someone could share with Dr Greger, is that 1. Does he know of this research and what does he think of it?
    2. If this is true (or even possible), is there any research at all on foods linked with raising igg levels?

    I read How Not To Die and was very interested on the section about Ig-A.

    If even there is some sort of blog post or something that dr Greger has already done on research into CFS/ME, I would love to know where it is! I know it is a mysterious disease, and I am just so thankful to God that a WFPB diet has been helping me so much!

    I can’t wait to be able to just go RUN like I did, or go do some outdoor climbing! I am about to go on my honeymoon in a week, and we will be in Yosemite so pray that I can go beast mode up to cloud’s rest like I want to so bad!

  9. Michelle,

    Congratulations on the partial recovery thorough diet change and on your marriage.

    I think it’s important to consider the findings of your one IGG subclass to be low in the context of repeat testing and in reference to your IGA and IGM levels. In the study I’m referencing they state: “Reduced levels of 1 or more subclasses may be found in healthy individuals, making precise clinical interpretation challenging. If performed, proper evaluation of IgG subclasses should include measurements on 2 separate occasions at least 1 month apart while the patient is free of infections”.

    For more on the IGG interpretation please see:

    In terms of increasing your IGG this can be accomplished using various less than bank breaking supplements. Prior to supplementation, I would encourage you to consider an evaluation test known as the Spectracell panel. ( to determine your current metabolic status, including overall immune response.

    I’d be remiss to not also ask if your using some nutritional yeast in your diet ? (

    I have seen a large number of CFS patients, who have gotten well. Typically when testing with the Spectracell panel I will also use an Organic Acids test ( to get an excellent picture of the patients metabolic situation and make appropriate changes.

    As a note the underlying issues of energy are often focused on mitochondrial function, that directly affects your biological energy potentials. You will find that there are many cofactors that can affect the mitochondria. There is no lack of both supportive literature and many clinical results that have helped many patients.

    Run some tests and check your system, followed by some experimentation with supplements and continue to eat well.

    Wishing you the ability to “go beast mode” up to cloud’s rest and truly enjoy your honeymoon.

    Dr. Alan Kadish moderator for Dr. Greger <a href

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