
How do you tell if a fish carries ciguatera poisoning?
Unfortunately, you can’t. Well, not until you’ve eaten it and either gotten sick or not.
And if you get ciguatera, you’re generally not just a little sick . . . you’re really sick, with both gastrointestinal and neurological symptoms. Worse news: there’s no “cure” or antidote. Even worse: symptoms can continue for months to years. More bad news: once you think you’re cured, many things will trigger a new bout – alcohol (even a single beer or glass of wine for some people), nuts, fish (even fish that doesn’t make anyone else sick).
When Gwen added a comment about ciguatera and their experience with it to my post about things to know about cruising in the Bahamas, my first thought was that I’ve probably known a dozen people with it. Then Dave and I got talking and it hit me that I knew far more than just a dozen. Maybe 50? 75? Admittedly, some are people I only know through their blogs, but nonetheless I know them. The actual number is probably more as I’m sure that some cruisers I know have had ciguatera and yet I’m not aware of it.
And that led me to want to know more, and also to want to write about it. I hear of more and more people affected every year, but I’ll be honest that I didn’t realize just how sick most of them were. I’ve also learned that many fish that were considered safe a few years are now on the “caution” list.
AWARENESS
Probably half the cruisers I know have “heard of” ciguatera – or that eating reef fish can make you sick. But I think that most are like Dave and I and don’t know much beyond that. Most of us don’t know how awful the poisoning is. I thought it was a nasty but “typical” food poisoning with gastrointestinal woes that went away after several days and don’t know what fish can carry it.
Ciguatera is not mentioned in most cruising guides and much of the information out there seems to be out of date. Everyone that I know who has gotten ciguatera says that they really didn’t know enough about it before they got it. No one realized that the fish they were eating might carry the disease, or how nasty the disease could be.
So, more than anything, I want to raise awareness.
WHAT FISH ARE AFFECTED
Ciguatera has long been known to be present in many reef fish – they eat a certain microalgae toxin and it just goes right on up the food chain, concentrating itself in those top predators such as barracuda and grouper. The ciguatera doesn’t affect the fish, only people (and their dogs and cats, both of which can get deathly ill) who eat those fish.
But now ciguatera is not limited to just top reef predators or even to just reef fish . . . there are over 400 species that are known carriers – and mahi/dorado and tuna are now listed as carriers (source: Florida Department of Health). It used to be that you only had to avoid the “large” specimens of reef fish; now people are getting sick on smaller fish too. A fish caught on one reef may carry ciguatera while another one caught nearby won’t.
Can You Identify a Ciguatoxic Fish?
Four things to know:
- There is no proven test to tell what fish is ciguatoxic and which isn’t. Giving some to ants or a cat and seeing if they will eat it is not reliable.
- Affected fish (whole or filleted) do not appear or smell any different than those not affected.
- Cooking or freezing won’t neutralize the poison.
- In broad average numbers, the chances of getting ciguatera are fairly small. Cruisers seem to have a higher risk, as they tend to eat more fish than average and do in changing locales where they don’t know the local prevalence of ciguatera and what to avoid.
Common Fish that Carry Ciguatera
The Florida Public Health Department specifically lists barracuda, grouper, amberjack, snapper, tuna, kingfish, eel, trevally, seabass, mackerel, hogfish, and mahi-mahi as known carriers.
In the reading that I have done, barracuda and grouper – particularly large ones – are the most common ciguatoxic fish. In the Florida Keys, hogfish also have a very high rate of being affected.
It is only recently that I’ve seen mahi/dorado and tuna on the list of carriers (both are pelagic and pelagic fish were always considered “safe”); most older lists don’t include them.
Further, several articles that I’ve read warn of the possibility of mislabeled fish fillets in fish markets, restaurants, and grocery stores. You might not be buying the “safe” fish that you think you are.
SYMPTOMS OF CIGUATERA POISONING
Symptoms of ciguatera poisoning can begin as little as 15 minutes after eating a bad fish but are more likely to first appear 6 to 24 hours later. Gastrointestinal symptoms usually appear first – vomiting, diarrhea and intense stomach pain and cramping – with neurologic symptoms coming one to two days later.
The classic – and unnerving – symptom is that of temperature reversal, with hot items feeling cold and cold things hot (this can be seriously dangerous with people taking scalding hot showers or burning themselves on hot drinks), although not all people get this.
Other neurologic symptoms include extreme itching, numbness and tingling around the mouth, hands and feet, teeth hurting and feeling loose, muscle and joint aches, and painful urination.
Symptoms can last from a few days to years. Older articles tend to talk about the symptoms going away generally within days, making it sound like an annoyance to get but not something that would affect your life for months to years. Newer articles talk about a longer recovery period with the possibility of relapses.
RECOVERY
Medical treatment is strongly advised. IVs may be needed to avoid dehydration. There is no cure or antidote, but various drugs can help control the worst of the symptoms. This is something to think about before eating fish in a remote anchorage . . . if you’re seriously ill, you’re going to have a hard time moving the boat to get to medical care.
And the symptoms can recur with the slightest provocation. According to the Florida Health Department, “people reported symptoms recurring months or even years after eating ciguatoxic fish. Triggers may include consuming antihistamines, seafood, chocolate, chicken, nuts, caffeine or alcohol. Participating in strenuous physical activity, taking cold showers, and smoking, may also reactivate symptoms. People affected should avoid unprotected sex and breastfeeding until symptoms subside as, in rare cases, these activities may transmit the toxin to others.”
YIKES! If I get ciguatera, I’m going to have to avoid beer, wine, nuts, chocolate and coffee for a year or more??
One friend described meeting a woman “who had obviously had a severe stroke.” Turned out that no, she had ciguatera two years before and was still recovering. Not everyone gets that severe a case, but some do.
WHAT TO DO
Basically, there are three things that you need to do while traveling in tropical waters, which is where there can be ciguatera.
Be Aware of the Ciguatera Risk
First, be aware of the ciguatera risk. For years, the risk has been considered small and manageable, with the advice being “just don’t eat large reef predators and check with local fishermen to see where the problem areas are.” This is what we had always followed.
Frankly, I think most of us are not aware that the risk is larger and potentially much longer term.
I’m not going to claim there’s a deliberate cover-up or anything, but ciguatera is a public health problem that affects numerous industries – fishing, fishing equipment, restaurants, tourism, and even charitable fund-raising fish fries. Which of them is going to go out of their way to publicize it?
Recent studies show that more people get ciguatera than cases are reported, but there are no definitive numbers. And they don’t know there has been a real increase in the number of cases or simply “asking the right questions.” Medical and public health experts no longer consider it “rare.”
Don’t Rely on Old Information
Second, as the research and knowledge of ciguatera changes over time, stay up to date on the risk wherever you are. For example, when we cruised the Sea of Cortez (2003-08), it was generally accepted that there was no ciguatera there. But I have no idea if that’s still true.
I have looked for – and not been able to find – whether ciguatera is riskier for children/elderly/those with other medical problems, but it’s something to consider.
Come Up With Your Own Plan for Eating Fish — or Not!
Third, make an informed decision about eating fish. Will you only avoid the top reef predators? All reef fish? Dorado? Tuna? Eat only what the locals are eating (say at a food stall)? Eat fish only when there are nearby medical facilities? Will you eat smaller reef fish? Eat only non-tropical fish?
For many cruisers, catching fish is a way of supplementing the food budget or having fresh food without a refrigerator, not just something fun to do. Dave and I are still discussing this; I don’t have a recommendation for anyone else.
MORE READING ON CIGUATERA

All at Sea magazine has published an article on ciguatera.
SAIL magazine Voice of Experience
An article in SportFishing magazine.
Public Health Department information
FL Keys: Ciguatera Cases Higher Than Records Indicate
This article was originally written in June 2016 and has been updated for accuracy and comprehensiveness.
More Food Safety
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Carolyn Shearlock has lived aboard full-time for 17 years, splitting her time between a Tayana 37 monohull and a Gemini 105 catamaran. She’s cruised over 14,000 miles, from Pacific Mexico and Central America to Florida and the Bahamas, gaining firsthand experience with the joys and challenges of life on the water.
Through The Boat Galley, Carolyn has helped thousands of people explore, prepare for, and enjoy life afloat. She shares her expertise as an instructor at Cruisers University, in leading boating publications, and through her bestselling book, The Boat Galley Cookbook. She is passionate about helping others embark on their liveaboard journey—making life on the water simpler, safer, and more enjoyable.
Maria says
Also known as the ‘seafood diet’? haha – sounds really horrible to have!
Ross Ginsberg says
Good to know but nothing can be done about it
The Boat Galley says
True that nothing can be done IF you get it, but there is quite a bit you can do to lessen the risk of getting it.
Rachel Roy Smith says
The Boat Galley don’t eat the fish….LOL
The Boat Galley says
That’s definitely one option that will eliminate the risk. Other options will lessen the risk but not totally eliminate it. Everyone’s risk tolerance is different so I don’t want to say what someone else should do.
Rachel Roy Smith says
great article…..we never ate fish the whole 10 years we lived on our boat in the eastern Caribbean. Our Antiguan friends would drink 3 glasses of milk at the first onset of ciguatera. They also told us that any fish without flies on it probably had ciguatera and should be avoided.
Nancy Tennyson says
Did they say the milk stopped the sickness from getting worse or lasting for a long time?
Rachel Roy Smith says
they said it actually stops the sickness, somehow the milk kills the poison. You must drink the milk immediately at the start. This is local knowledge, we never had to test the validity.
The Boat Galley says
I’ve heard several places that the presence or absence of flies isn’t a reliable test nor is putting a silver coin or coconut in the pan and seeing if it changes color.
Nick says
There was a study done about these types of tests and only 2 proved to be somewhat accurate. Rigor mortis test and tail hemorrhagic tests, proved to be 70% successful in IDing fish with the toxin. The rigor mortis test is basically if the fish doesn’t stiffen after 1 hr it should be avoided and tail hemorrhagic test is if there is bleeding in the tissue near the tail the fish should be avoided.
Rachel Roy Smith says
the fly theory is one the local Antiguan fishermen believed in………who knows if it’s factual or not! Just local knowledge passed down from generation to generation!
Elissa Ray says
Maybe a dumb question – but what did you ear?
Rachel Roy Smith says
chicken, pork, beef and lots of veggies and some pasta…..we didn’t have refrigeration and used a cooler so I shopped every few days…It worked for us!
The Boat Galley says
There’s plenty of other food to eat! 🙂
Philippe Larose says
Wow, that even the dorado might be listed was surprising to me. We ate quite a few fishes back in 2011-2012 but did avoid barracudas and larger jacks.
The Boat Galley says
Yeah. Dorado really shocked me. Ditto for tuna.
Philippe Larose says
🙁
Nicola Kamper says
We think that Marc suffered from Ciguatera a few months back in the Bahamas. A friend invited us to dinner and served a delicious grouper. Marc got sick but our friend Michael and I did not. Marc was violently ill all night and not quite himself for a couple of days afterwards. I am concerned because apparently the toxin is accumulative. Since we eat the same food, am I just one meal away from tipping the scale and succumbing?
Hendrik Vergeer says
Go straight to the hospital and insist on mannitol treatment
The Boat Galley says
A number of newer studies question whether mannitol works or not, and it has a lot of side effects. Something to discuss with whoever is treating you as the recommendations change all the time.
Gwendolyn Webster says
Thank you so much, Carolyn, for your thorough writings on this terrible poison. Gary and I are still suffering from these symptoms (is only been one month) and for the most part, learned what to avoid that exacerbates these symptoms. We just got back from Bimini after eating fresh Mahi, Snapper and Grouper. It is extremely annoying and thank goodness that we didn’t need to be hospitalized. High heat outside (the desert, in the shade) and very cool air (A/C blowing directly onto your skin) makes our skin very uncomfortable and feel so odd. The heat reversal and mouth itching along with the tongue feeling like it’s been burned, with cool drinks tasting like bad carbonation leaves us with drinking only room temperature water or tea. Legs and joints still suffer with exhaustion just from walking from one of the boat to the other. Fish was a very large part of our diet. It will be missed.
Jason Diesel says
After reading this, even eating at a local island restaurant could give you this…
The Boat Galley says
Absolutely. It’s not just fish you catch yourself. And when I was Googling for info, I found outbreaks such as 17 people getting it at a restaurant in St. Louis — far from the ocean, but fish are air-shipped everywhere now.
Penny Fuller says
I have had it and as I understand it I will be more sensitive to this toxin for ever.
I did know the dangers of eating reef fish. I landed a huge old Horse Eyed Jack and was fully aware that it could be infected….so(without understanding how the toxin worked) I thought I would take the precaution of just eating a small amount myself before offering it up for dinner to others. I ate a small portion probably about 1/4 lb…I felt fine. The next day I cooked 4 large portions for my husband myself and two friends, at least 1/2 lb but probably more….we were all fine. On the third day I ate the whole rest of the fish all by myself yes, it was gluttony! Probably about another 2lbs…. About 12 hours later,in the middle of the night I woke up so ITCHY all over! Couldn’t sleep. I thought I was having an allergic reaction to the laundry detergent or something. When I began to feel tachycardia, it occurred to me that It could be the fish. We were far far from anywhere at least one day from Turks and Caicos. By the next day I was suffering wit bouts of severe exhaustion, muscle fatigue like I had just run a 6minute mile, just from walking 10 feet. It only lasted a few minutes or so each time but this was the worst part. Cold was hot and hot was cold and the itchiness continued too. The tachycardia went away after about 48 hours but the other symptoms went away very slowly over atleast two months! Sudden onset of fatigue and itchy palms and feet when I least expected it.
So what I have learned is that the toxin builds up in your system and stays. Some people may get lucky and vomit out much of the toxin before it gets absorbed…. My body didn’t recognize it until it was too late. I will never eat reef fish again but it is clear that I love fish and I refuse to stay away from dorado. This may indeed be foolish, only time will tell
Genevieve Stolz says
I feel your pain, our whole family got it a couple of years back
Chantal says
Hello Gwendolyn,
I too, contracted Ciguetera from grouper in the Bahamas, not fun at all!
How are you doing and what food did you have to remove from your diet or which one were a trigger to your symptoms?
Thanks for sharing!
Chantal
Gwendolyn Webster says
Hello, Chantal:
It’s been 2 and half years since we were sick with Ciguatera and we are symptom free. For 6 months, I had to avoid processed nuts but raw nuts were fine. Alcohol was a big no-no, hot was cold, and protein didn’t cause any flareups. Compared to some, we were very lucky.
It is so difficult not to be able to eat the fish we used to love and to not be able to eat fish out at a restaurant (for the most part) is frustrating. I was literally told by a server at a restaurant that all their salmon was wild because they are “in danger”. He said their chef didn’t know if their fish was wild or not.
Weight gain has been a problem because we used to eat fish 3 or more times a week. The muscle fatigue lasted for so long that exercise was difficult.
Even though we are symptom-free, I am so very careful about what fish I ingest for fear of adding to this neurotoxin. Never again, is my motto!
How are you doing? Let me know if I can help in any way.
Warm regards,
Gwendolyn
Chantal says
Hello Gwendolyn,
Thanks for your reply, i really appreciate it! 😊
I’m glad you are now symptoms free its very encouraging to read that! There is hope…
For me it’s been only 15 days that i was infected by the Ciguatera toxins…
My symptoms are hot/cold reversion, i fatigue very fast, low muscle srenght, difficulty falling asleep or staying asleep for the night, I’m not as itchy anymore which is good.
Yes If i may, I do have a few questions for you. Did you have to remove other food items from your diet? What about quinoa or vegetal grain fed chicken, chocolate, coffee?
Did you take any medication at all?
And since you are now symptoms free, did you try a little wine?
Thanks again,
Chantal
Gwendolyn Webster says
So happy to help! We had no problem with any proteins and we did read that chicken and beef could cause symptoms to worsen. Love quinoa, by the way. The only thing that bothered us besides the processed nuts was the alcohol. It bothered us terribly in, well, in the nether regions. Gary was able to drink wine in about 2 months, and it took me about 6 months and that was with one, teensy sip.
No meds, as we read that really nothing would help. Walking up 3 steps was enough to put me into a sitting stage for half an hour. The muscle fatigue was awful. The hot/cold reversal kept us in room temperature water for about 6 months. Our afternoon iced coffees became non-existent. They burned our mouths.
We are able to eat and drink all foods now, thank goodness. I still read that some folks have symptoms after 9 years. We ate so much Mahi and Grouper in the month we stayed in Bimini, I thought we’d never be symptom-free. It started with itchy soles of the feet and palms of hands.
I was really glad that I called the CDC and the local state poison control center. They diagnosed me over the phone with all of my symptoms. I couldn’t believe it. They are really trying to keep track of this toxin and asked what latitude and longitude we ate the fish!
They called every day for 2 + weeks to check up on us. They were so helpful and caring.
Let me know how you progress and we wish you a speedy recovery.
Warm regards,
Gwendolyn
ChrisW says
One of the reasons you are seeing fish not previously identified as carriers and more instances among fish that have been known to be are fishing pressure on the affected populations and environmental pressures on oceans. This manifests itself in several ways, plus one wild card.
As reefs become unhealthy, some reef fish begin eating micro-algaes that are not part of their normal co-evolved food supplies.
As fishing pressures on stocks increase, more border-line fish (too large) are kept rather than being released, and problematic fish (as you said) are slipped into the human food pipeline.
As fish populations shrink more apex predators become less selective in their diet.
As plastic debris rafts increase in number and scale they become the equivalent of unanchored reefs with their own micro-algal flora and open ocean predators become concentrators.
As humans become more dependent on drugs for health maintenance and food preservatives for supply safety, toxic interactions become more frequent and less manageable.
Gwendolyn Webster says
Carolyn: Another note I wanted to mention was that the Poison Control Centers (especially in Florida) want you to keep a piece of the fish that you suspect gave you this toxin. I am sorry that we weren’t able to send the fish we ate to them. They will continue to do testing to try and come up with antidotes and test kits for these fish.
Carolyn Shearlock says
Thanks for adding that!
Ruth Walley says
Yes we got it in the Carribean from a mackerel that was given to us from a fellow cruiser. Very itchy palms and feet that came and went for several days.
Else Heijnes Reed says
A Dutch couple just got killed by eating contaminated fish on their honeymoon.
Gwendolyn Webster says
This is so terribly sad!
The Boat Galley says
Yikes! I have heard that it can be fatal but horrible to hear about it.
Else Heijnes Reed says
The Boat Galley http://www.nltimes.nl/2016/06/29/poisonous-fish-cause-dutch-newlyweds-death-dominican-republic/
Genevieve Stolz says
I still think back to how horrible that was!!!!
Maryanne Grady says
Serious stuff!!!
Lars Lillo Ulvestad says
I dare you to experiment and develop some boat friendly vegan recipes 🙂
Megan McCuin says
Jeez that is some serious stuff. How is it I’m just now hearing about this? Where are awareness posters for this?!
Jessica Baker says
Was told 25 years ago, be careful what fish you eat. The local St. Thomas fisherman would sell their catch at market, most are reef fish and they will make you sick.
Shane Saah says
Well, thank you for ruining hog fish for me!
Sabrina Nichols says
Good info. Question – what about Lion Fish? Don’t they feed on reef fish? We find them very tasty and like the fact that eating them helps reduce the number of this invasive fish.
Gwendolyn says
The lion fish isn’t on the list of fish to avoid. But I wouldn’t eat any fish that eats from the reef or one that eats the fish who eat from the reefs. You’re right about helping to rid the ocean of these invasive species!
Carolyn Shearlock says
I’ve seen articles both ways on lionfish . . . consider its voracious appetite for reef fish, I’d expect it to be on list but it doesn’t seem to be. I’ve read a couple of articles such as this one that talk about the fact that (1) as of 2014, there were no confirmed cases of ciguatera from lionfish and (2) that lionfish toxins and ciguatera toxins are very similar and thus can be confused for one another in standard testing; however, since lionfish toxins break down if the fish is cooked, studies to see if lionfish are ciguatoxic should be done on cooked fish. But I haven’t seen any articles that discuss such a test program being done.
So at this point all I can say is that I can’t find any reports of anyone getting ciguatera from lionfish. However, ciguatera is quite underreported, so there may be some cases.
cndy says
I got it from Lionfish on Grand Cayman in 2009. My scalp still has hot/cold reversed so I have to be careful about showering. That was the only fish I ate on the trip and I was the only one that got it. Everyone said that it couldn’t be from Lionfish and I just had a stomach bug but I had all the symptoms. The Caymans have been devastated by the Lionfish epidemic and the smaller reef populations have been decimated. My case wasn’t reported because “Lionfish are safe”. (Because I was at a fish fry for promotional purposes)
Gwendolyn Webster says
CNDY:
I am so sorry, CNDY, that you have suffered from this poison for so long. Thank you so much for writing and informing us of the Lion Fish. It makes so much sense, since this fish eats everything in sight and loves the reefs. I wish for your recovery sooner rather than later! My fish intake has taken an extreme hit and husband and I miss it terribly. We have to be so careful but do not have any symptoms after a year. Best wishes to you.
Gwendolyn
Christine Beckstrom says
Appreciate the information about ciguatera. My husband and I are retiring next year and will be heading for the Bahamas. I have heard of this toxin but until I read your account did not realize the seriousness of this illness. Along with your information and doing some additional research has helped us with our decision. Although we love seafood, the risk is not worth the possibility of living with the aftermath in our golden years. Great website, we refer to it often.
Merlin Brasil says
we may be seeing progress, including a ‘soon be available’ test kit.
I’ve now got this solidly on my research ‘radar’ and will follow up as I discover more.
Regards,
Merlin
Victoria Beaver says
What about shark?
Carolyn Shearlock says
Shark is on many lists of “don’t eat” — I think it’s not mentioned as often as say grouper or barracuda just because not as many people eat it.
chris says
Shark is very high in Mercury … as are bonefish, cobia, king mackerel, Spanish mackerel, get grouper, red grouper, tilefish, banded rudderless, jackpot cravalle, albacore tuna
Merlin Brasil says
Found the company making the test kit. Very quick response to my email enquiry:
“Thanks for your email. We’re currently selling our kit through MARBIONC (www.marbionc.org). I would be happy to provide you with specific information about the product if you’d let me know what information would be helpful. I’ve also copied in Karin LeMaire with MARBIONC as she would also be able to provide you with additional information as well.
Sam McCall
SeaTox Research Inc”
to which I responded:
Thanks for the quick response, Sam.
Frankly, the $500 price tag for the kit pretty much leaves this inquiry dead in the water.
To elaborate, consider me representing tens of thousands of ocean cruisers, many based in the Caribbean, who fish as part of life on the earth’s oceans. Add to that the many tens of thousands of shore-dwellers who like their seafood!
The two-hour turnaround time for the test is workable, but nobody in their right mind will spend $500 to test the 5-20 fish they caught, or buy from the store, to avoid the horrible consequences of Cig poisoning. They will simply continue, as they’ve done for generations, playing Russian Roulette with their health.
What’s needed is a Lab-On-A-Chip specifically targeting the Cig poison. And that would have to be mass producible and relatively cheap. For the populations of villages who depend on fishing for their livelihoods, this could be a critical life-saver.
Do you know if anyone has run the concentrated Cig poison through a Mass Spec to see atomically what the composition of the nasty agent is?
Thanks again,
Merlin”
I’ll let you know as this proceeds.
Merlin Brasil says
Latest response (and he is definitely speedy and responsive!):
I appreciate your feedback. We absolutely understand the importance of ciguatera and are working every day to find solutions to the issues presented by ciguatoxin and other marine toxins. Our current product is not designed to be used by laypersons. It is a research product for use in testing laboratories and those administrative labs charged with controlling fisheries. We’re working on future products that would more user friendly as described, but these solutions take time to develop. While a $500 price tag may seem high, it is able to test multiple samples on one plate, depending on format and is priced competitively in the market.
Again, I appreciate your correspondence and would be happy to provide any additional information about our assay you may find helpful.
Best,
Sam
Merlin Brasil says
Following up further, I received this response:
“Ciguatoxin has been qualified and quantified by mass spec but mass spec presents its own challenges, namely, the cost of equipment that can easily top $500,000 and required knowledgeable users. Facilities that have the equipment and expertise routinely charge $100-200 per sample for analysis. Unfortunately, identification can’t solely lead to a cure. Other methods would be required to cure the actual disease and due to the nature of the ciguatoxin molecule itself, it is very difficult to produce materials that could be used, not only to identify the toxin cheaply, but to treat ciguatera disease. Thus the importance of our test to allow regulatory agencies and researchers to identify high risk fish and make recommendations for public health reasons.”
Gwendolyn says
Merlin:
Thank you so much for providing this invaluable information! Wow, they are so responsive and interested in the seriousness of this toxin for us boaters – and land folk. This information will go into my getting-larger-everyday-Cig folder.
Ash Willis says
Is lobster affected?
Carolyn Shearlock says
There have apparently been a few cases of lobster causing ciguatera and also — more oftenly — of it causing a relapse in someone who had ciguatera in the past.
Judy McCarten says
Good work bringing this information up for discussion. You may also find this enlightening and interesting- good luck and thanks for your notes.
http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/food-poisoning-from-marine-toxins
Cookie johnson says
So, are fish you catch in the ocean or gulf safe because they are far from reefs? Are shrimp and scallops still safe?
Carolyn Shearlock says
It’s long been thought that pelagic (ocean/gulf) fish were okay, but that is getting a little suspect with mahi and tuna now being added to the list of carriers, probably for the reasons ChrisW discussed above. I don’t really know about shrimp and scallops — I’ve found a few people who think they may have gotten ciguatera from both, but nothing very definitive. Also found several cases where the “scallops” turned out to actually be cut from the wings of rays (sold in stores sometimes as “skallops”).
Kim says
The fish that got me was “Wahoo.” however I suspect that I might have had a high risk of exposure previously over a lifetime of eating reef fish including some big ones.
Merlin Brasil says
http://www.sportfishingmag.com/perils-ciguatera#page-21 has some helpful info and possible “cures”.
Regards,
Merlin
Dennis Tye says
In the Bahamas, i asked a local man about eating barracuda. His answer was “we’ve eaten it all our lives, and are immune to that disease”.
Just a thought.
Great article Carolyn, Hi Dave
Carolyn Shearlock says
A couple weeks ago, we were at a town barbecue (we were the only out-of-towners; it was definitely NOT a tourist thing) and one of the stalls was selling grilled barracuda with a big sign “Eat at Your Own Risk!” so maybe they’re not ALL immune.
In all seriousness, as I understand it, the toxin accumulates in people just as in fish. You don’t build up immunity over time, you actually become closer to the tipping point. Locals may seem more immune as they know which areas not to eat fish from.
Tiffany Graham Showalter says
Just came back from USVI where we caught a huge king mackerel. He provided us with dinner over several nights and ciguatera poisoning forever. None of us had any digestive issues. All neurological (I.e. Itching, hot/cold reversal, headaches, muscle aches, fatigue) Looks like we only had a minor case but are all still symptomatic 4 days past last ingestion.
Gwendolyn says
Oh, Tiffany, we are so sorry that you contracted this toxin! Gary and I are still symptomatic 6 weeks along. We are better in some ways, so we wanted to let you know that things will look up for you. Most of the fatigue is gone, the muscle aches are less pronounced (we can walk about half a mile before sitting down to rest and stair climbing has gone from an impossible 5 steps before losing breath to now a couple flights of stairs), headaches come on at the oddest times, itching is less but constant and avoiding anything that exacerbates the symptoms has been really helpful. Gary has just started back with drinking a bit of wine even though it makes him itch. I cannot have one sip of alcohol or my skin goes off the charts. A bit of dark chocolate is our choice of dessert after dinner: not for me as it makes my palms and feet itch like crazy. Not eating any fish at the moment is very frustrating as we were huge fish consumers. The cold reversal is the one that still plagues us. We are just now able to drink water that isn’t completely room temperature but still have to use something to protect our hands while holding anything cold from the fridge.
The Poison Control Center in FL and the FL Health Department has kept tabs on us and now that we are back in CA, the CA Poison Control Center just called to see how we are doing. They have been amazingly helpful and caring and we feel good about helping them will all of our symptoms so that they can keep track of this awful toxin and hopefully, one day very soon, will be able to have a kit to test on fish. We are hoping that you will be well sooner rather than later!
Linda Stevenson says
We are at Great Sale Cay, Bahamas. Two local elders separately assured us that any fish caught north of Grand Bahamas is safe from Ciguatera. We’ve had Grouper that we caught and also some from Rosie’s Place (restaurant) with no illness thus far.
Gordon Mac says
I talked directly to Oceanit, the company in Hawaii that used to make the $25.00 test kit. I was told that they stopped making the kit as there were not enough sales which meant not enough profit. And because they hold the patent no one else can make the same type of cheap test kit… Nice people, huh??
Gwendolyn Webster says
Wow! I can’t believe they said that to you. From my understanding, the testing kits that were made in HI didn’t work and this is the reason they stopped making them. If they had worked, I’m sure they would have not been able to keep up with sales had their product could, indeed, detect whether or not this horrid toxin is in the fish being tested.
My husband and I are so fortunate to have suffered from Ciguatera Poisoning for only 4 months and I would not wish the symptoms we had on anyone. We treated the symptoms only by avoiding what inflamed the symptoms. It was a miserable time. We look forward to the day that a test will be available and let people know it is so important to report Ciguatera Poisoning to the poison center immediately. They were really helpful and called a number of times to see how were faring.
After one year of avoiding all fish, we started back with only non-farmed fish that aren’t on the 400+ list of fish to watch for. And, we’ll never eat fish again from any type of restaurant.
Thank you, Gordon, for writing.
Jeff Hansen says
Geographically where does ciguatera occur? Caribbean areas only or worldwide ??
Carolyn Shearlock says
Worldwide. I know several people who have had it in the South Pacific as well.
Butch Leone says
Very true, it is in the South Pacific. I live on Aitutaki in the Cook Islands and it is here also. One of the most prevalent fish that has it is the trevally. I got Cig 1 time from a trevally that I did not take the fillet off but rather left it on the bone in chunks. After that I have always taken the fillet off and never had another problem. I have given the bones and head to a neighbor, because he insisted that was the best part, and he got very sick. I had no effects whatsoever. I have lived here for 20 years and eat trevally sometimes up to 4 times a week so the cumulative effect should have certainly had its affect on me by this time. I will continue to eat these fish but will never leave it on the bone but rather fillet them and take the red meat off. Supposedly it is a neurotoxin so taking it off the bone eliminates the spinal column and the red meat is also a nerve channel. I think the heat from cooking it on the bone leaches the toxin into the flesh from the nerve channels. Just my thoughts
Carolyn Shearlock says
Interesting. I do know other people who have gotten sick after eating fillets, so can’t really explain the difference. But certainly glad you haven’t!
Kim Perry says
I have chrinic ciguatera. My symptoms included severe tachycardia , changes to vision and other neurological problems. I have had it for almost 19 months now. Before.a neurologist solved my mystery illness I was in the ER 9 times, 6 by ambulance. The fish I ate was Wahoo caught in Cabo. The Fish was caught hy a friend. Take this condition seriously. I have had a serious arhytmia and life haltng neurological problems. My triggers and those of others go far beyond the short list you see on most websites. Foods, lotions, tenperature change, microscopic amounts of caffeine set me back. I carry an emergency beta blocker for the tachycardia. I spent a year at medical centers even Scripps Institute without knowing what this was. I was treated in the ER the night of my illness. The neurologucal symptoms came afte the GI symptoms,, pain and exhaustion and started about 3 days later and progressively got worse for 5 months. I cannot emphasize enough how bad this toxin is.
Gwendolyn Webster says
Kim:
I am so very sorry for what you have had to endure. I am wishing you recovery sooner rather than later. My husband and I suffered for only 3 months – it seemed so long at the time. We really miss eating our favourite fish! While we don’t suffer symptoms of this terrible toxin any longer, we have been forever changed and wouldn’t wish this sickness on anyone. I am astounded how little this sickness is discussed, especially in the boating and fishing industries.
Best wishes to you,
Gwen and Gary
Natalia says
Hello. I do belive I have Ciguatera. Have all the symptoms, can anyone help? Im really scared and having a hard time dealing with this. My fist severe symptom was on August 22, and I continue to have them. Cold and heat reversal. Numbness and tingling around my lips, dry mouth, feeling like Im falling from a cliff and my body burns like its on fire.
Please help
Carolyn Shearlock says
Natalie-you really need to go to a doctor. It will take time to recover.
Gwendolyn Webster says
I’m so sorry, Natalie, for what you are suffering. I, too, as Carolyn suggests, feel you should see a doctor. Husband and I suffered for several months with some terrible symptoms and, at the time, there wasn’t anything the doctors could do to relieve them. They have finally subsided, and I’m hoping that today there may be relief that we haven’t heard about since last year.. Be careful with the hot/cold reversal. We wish you the best and for a quick recovery.
Gwendolyn
Rachel Savitt says
Thanks so much for the info, my husband and I are on our first cruise to Florida and Bahamas and we did not know anything about this. He was so excited about spear fishing and fishing off boat , I think we will rethink this!! So sorry for all those posted about their experiences
Shelly says
Thank you for bringing this into the limelight with detailed info! I am a PT and have never had a patient with this despite working with neurological symptoms & had only vaguely heard of it until now. We have been what a cruisers book we read calls “defacto vegetarians” more because we have no fridge than any other reason. Now I have my reason to not add fish in!
Stacey says
Hello! Thank you everyone for sharing and I’m so sorry for what you are experiencing. I had GI symptoms about 2 weeks ago on a cruise to the Bahamas. After returning home, I started having tingling in my hands/feet, feeling cold when it was hot, severe anxiety, itchy soles, severe nausea/not wanting to eat, sweating at night, sweating of my palms/soles, shaky extremities, weakness, fatigue and trouble sleeping. I felt like my heart would beat from my chest, but my pulse and pressure were always fine. I live in Indiana and have had a battery of tests- all of which are normal. I’ve been seen in the ED after almost passing out last weekend. I was almost at my wit’s end until I found out about Ciguatera.
Thank you for sharing your stories, because now I think I finally understand what I might be going through. I had Mahi and a ton of other seafood on the cruise. Wishing you all the best and a Happy Easter.
Kim says
That is the scary reality of ciguatera. I spent 12 months in ERs. Go see a functional medicine doctor, specifically one that treats biotixins like mold. Dr Michael Arata in Irvine California is who I recommend.
Start the Ciguatera diet immediately. Eliminate high histamine foods. Take this diet very seriously. The beta blocker drug Nadolol has been my saving grace for the symptoms you list. Ask for the prescription Cholestyramine.
Go online and complete a VCS test for visual disturbance. Do this monthly to follow your improvement or ups and downs.
You need to have the following bloodwork: VEGF
TGF
C3a
C4a
Ferratin
Your hormone levels.
Contact me if you like. Text me at(804) 339-3813
It is very important that you get on the diet really now. Go see a functional medicine doctor as soon as possible. They will help support your body through detoxification. Read up on Dr Richie Shoemaker and biotoxins. This can be a train wreck or a blip in your life. It’s a good thing you know what this likely is, now get to work helping your body heal.
Nick says
Hi Kim,
I’ve been reading the many helpful comments on ciguatera and found your insights especially useful. I’m 99.9% sure I have the poison – from the initial dizziness to several vomiting/diarrhea a few hours later for days, followed by constant fatigue, headaches and many other symptoms that have lasted for eight weeks now since I did the fish tasting (am pretty sure it was from Sea Bass I ate in Barcelona).
I couldn’t get to see my doctor until next week (welcome to American health system!) and I wondered if you had any specific advice. It’s a complex toxin and there’s a chance she’s never encountered it before. You mentioned Nadolol and Cholestyramine. I’ve also read B12 shots can help too. But do you have any advice on what helps the most? As this is my first visit I want to make sure I make the most of it.
Appreciate any and all advice as this has really sucked the life out of me!!
Nick
Anonymous says
I didn’t realize it had gotten so bad!
Anonymous says
Yikes.. never heard of this before. Been in Key West all winter, eating hogfish, tuna, conch, shrimp….
The Boat Galley says
I don’t want to be alarmist, but also want to inform so people can make their own decision.
Anonymous says
Yikes
Anonymous says
Alison Stroebel
Kim says
I will be the alarmist for you. Ciguatera can have a life long affect on some people. The reasons are not well understood but some develop a lifelong Chronic Inflammatory Response syndrome. This same kind of extreme response can happen to other biotoxin exposure victims.
My saving grace has been the researchers advice at ILM in Tahiti and a functional medicine doctor. At 29 months past onset I am slowly gaining back some normalcy but my heart is still affected. Here is what I know based in years of research:
Any reef fish can be a risk. Mollusks and shellfish can have the toxin too.
Pelagic fish are not risk free (wahoo got me)
Exposure can build up- called Straw That Breaks the Camel’s back theory.
Get manitol within 24 hours if at all possible.
Ciguatera can be life threatening.
Local myth theories on how to identify bad fish have not tested accurate.
Neurological
Symptoms can develop immediately or over weeks.
Cardiac effects of both high and low heart rate and POTS Can be caused by Ciguatera.
Once you have it the risk of a severe reaction upon more exposure skyrockets.
Good luck out there.
Sue says
Hi Kim
I also have all symptoms that you have mention 3 weeks into now . I have been working with a homeopathic person who has given me a few items to take for relief. Another helpful item to help others is chelation which has also helped with improving my energy but $$$. I’m drinking raw milk too , told by someone that helps with absorption of the toxin to avoid it going into your fat cells. I’ve loss easily 7 pounds , very fatigue going up steps are the worse . Tachycardia definitely comes and goes . I have an appointment for a cardiologist in a few weeks . The western doctors are clueless here in Florida. The health department did take our fish for further testing which can take a few weeks . Waiting to hear back from them , who have been very helpful . My “ story “ is that I was heathy , ate a fish , now sick forever.
I notice caffeine can be a factor but I’m still drinking coffee every morning . The one item I love but probably need to give up since I still have a lot of these symptoms … hot , cold reversal , Teeth pain , numbness , tingling , cramping ..I’m glad to read from many on this blog since their isn’t many doctors to treat this horribly crazy effect on our human body .
Anonymous says
Mahi-Mahi nailed me 5 years ago in Antigua. It put me down for 12 months. The worst of the symptoms lasted for 6 months, the thought that they could go on for 20 years is most frightening at the time. It was like being tortured every day. The pain was truly horrific, I thought it would never stop.
5 years on all I have is a tingling in my left arm every morning as a little reminder while I wait for my relapse. On a brighter note it was the best tasting fish I have ever eaten!! Good to see you spreading the word.
Trent Thomas says
A friend of mine got it from eating a big Spanish Mackerel caught out from Cairns, Queensland, Australia and his doctor told him he couldn’t eat fish again but he lived on fish so he searched for more advise. He was told to eat a Cod Liver Oil health product and he said it made the symptoms a lot more bearable and after a while the symptoms went away altogether and he is back eating fish. We used to eat lots of coral trout/grouper in Cairns and never got sick but I now live in Vanuatu and we are told not to eat any reef fish here. The local people eat lots of small reef fish and it is quite common for them to get sick from the fish.
Garry Jordan says
Why is it that ‘Locals’ constantly eat ANY reef fish and you never hear of them contracting the disease?
I have lived in Vanuatu for over 10yrs and never once heard of locals getting it but there have been a few cases of Expats getting it.
Carolyn Shearlock says
They tend to know which reefs are okay to fish from and which aren’t, I think.
Linda Stryker says
My nephew got it from a barracuda restaurant meal on a trip to Florida, at age 25. The effects took months to clear.
Anonymous says
Is it as problematic in the Pacific as it is on the east coast?
The Boat Galley says
When we were on the Pacific coast of Mexico and in the Sea of Cortez, I didn’t hear of anyone having a problem and in fact, we were told that there was no ciguatera there — but that was over 10 years ago. I don’t know what the situation is now. There is definitely a LOT of ciguatera in the South Pacific.
Mel says
Hi all,
I’m an Aussie and got sick in the Philippines after eating fish. It was the scariest week of my life. We were stuck on a boat for days and was scared for life. I was so dizzy and blacking out constantly with what we thought was just a horrendous case of food poisoning.
Long story short 2 years on and still suffering weird dizziness, off balance, blurred vision, distorted perception, buzzing like electric shocks through my body, plus a weird nausea that results in constant belching. It feels like I am on an acid trip that won’t stop, For 18 months we didn’t know it was Ciguatera and went through so many doctors and practitioners.
I only found out it was Ciguatera via a MORA machine which picked up the toxin. Am working with homeopathic remedies to try and shift it.
I still have no relief after trying sooooo many avenues and it’s turned my life upside down.
I will never eat fish again and am just hanging in there and waiting until things start to improve.
I believe there must be life after this, and when I start feeling somewhat normal I will never take another day of my life for granted again.
If anyone has an contacts in Aus that they feel maybe able to help me please let me know. I’m in Noosa QLD.
Luc says
Hey!
I have been sick since eating fish in the Philippines too.
Dr Bernard Hudson in NSW diagnosed me recently (no testing obvs).
I’m on Cholestyramine at the moment, coupled with using the Visual Contrast Sensitivity test as a marker for progress.
Give it a go.
I hope you’re improving slowly like I am.
Thanks
Luc
Christine Scurr says
Hello Mel
I live near Cairns, north QLD. Here I am back on here after my dose of poisoning from Spanish mackerel in 2018, so your comment is new, and the reason is now I am suffering a second dose after mackerel on Friday night just gone. I wanted to pass on my experience and I hope it is helpful. The first time, I didn’t know what it was (in fact had never heard of it) until about 6 weeks in, where I eventually seen my naturopath/iridologist Christine Ludke. My symptoms were only vomiting and diarrhoea, some tingling in the feet, fatigue and nausea. She put me straight on a strict 4 x day four day detox of Dr Lugols iodine and the liver herb Iberogast. I have never felt so ill in my life while my body detoxed and could barely face doing the 4th day but I pushed through. On the 5th day I felt completely normal, and have not suffered any symptoms right up to now. For 3 years since being cured, I have consumed all types of seafood, up to 3 times a week. So to be experiencing it again proves that once you’ve had it, you are very susceptible to getting again and maybe the toxins begin to build up again in the body. This time, there has been no nausea or vomiting, only diarrhoea, fatigue, tingling and shocking stomach cramps. I also know I may have regular food poisoning from the fish, but am immediately doing the detox again, which along with charcoal, is recommended for any type of food poisoning. I won’t eat fish again, maybe only farmed salmon. I will come back on here after my detox to update you. Best wishes.
Jim (S/V Amity) says
Excellent article! We up here in the northeast don’t have the problem in our local fish but when buying fish from one of the big supermarkets, who knows where it comes from. We only buy local cold water species and stay away from the tropicals.. Ciguatera sounds like the marine equivalent of Lyme disease except no known cure.
Simone says
Great article! It is important to spread information about ciguatera, since so few people know about it, especially in countries that are not directly in contact with the problem.
I found out what it was only two weeks after I got it in cuba by eating swordfish in a touristic restaurant. Doctors here in europe had no clue at first, and the fact that swordfish is generally not included in the affected fish lists didn’t help. Having those strange symptoms and knowing nothing about it was nerve wrecking.
Dianne says
Is there a list of fish that are safe to eat? (We are currently in Boot Key. I am away for work but my husband will be at the Bahamas meeting tomorrow!)
Carolyn Shearlock says
No, there isn’t since almost any fish can carry it. And you’re almost next to us! We’re on G4.
Dianne says
Oh wow!! I hope I get to meet you. I’ll be away until Feb. 1 and when I get back we’ll look for a weather window to cross for our first time!!!! I have 2 of your books – one at home and one on the boat 🙂 You’ve been a big part of our journey from dreaming to cruising. Thanks for all you do. – Dianne
David King says
Here’s a .pdf and a link from Hawaii’s Gov website
https://health.hawaii.gov/docd/files/2013/05/dib_ciguatera.pdf
Planning on a move to Hawaii and wanted to be up to date!
BC says
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579736/
Barbara Bailey says
I got it in 2014 while working/living on New Providence Island (The Bahamas). A grouper filet was the culprit. Was semi-conscious when found. Side effects lasted six months, and included extreme hot/cold reversal and extreme itchiness of skin, especially on my face. No reoccurance of symptoms/side effects since then.