Ciguatera: an unusual type of food poisoning with lasting effects.
Growing up in New Zealand in a family of sailors, I spent much of my childhood on the water. With family and friends sailing through French Polynesia, I learned early about something that isn’t always on a traveller’s radar: ciguatera fish poisoning; an illness whose effects can last long after the initial digestive upset has passed.
Although I’m better known for my work in women’s health and fertility, I wanted to share a longstanding interest that sits a little outside my usual topics.
My clinical interest in ciguatera began years ago when I saw a patient who had experienced unusual symptoms for a long time. Remembering what I’d learned through my sailing connections, I called a knowledgeable colleague in New Zealand and asked, “Could it be ciguatera?” That conversation prompted me to explore the condition, traditional Pacific remedies and the history of Chinese medicine’s approach to fish poisoning.
Since then, I’ve seen a few patients whose histories have raised the same question. None had a confirmed diagnosis, so I cannot say that ciguatera caused their symptoms. But those encounters reminded me how valuable it can be to ask about an illness that happened years earlier, particularly when its effects may seem unrelated to the original episode of food poisoning.
What is ciguatera?
Ciguatera is caused by eating fish containing ciguatoxins. These marine toxins originate from microscopic organisms associated with tropical and subtropical reefs and move through the food chain. In Australia, Most ciguatera fish poisoning cases in Australia are found in tropical and sub-tropical coastal waters of Queensland and Northern Territory.
Larger, older predatory fish can accumulate toxins as they feed. Fish associated with poisoning include Spanish mackerel, coral trout, barracuda and some species of snapper and trevally. However, size alone cannot tell you whether a fish is safe: the species and where it was caught also matter.
Contaminated fish may look, smell and taste completely normal. Unfortunately, cooking or freezing does not destroy the toxin. Following local advice about high-risk fish and fishing areas is essential.
The unusual symptoms: when cold feels burning hot
Ciguatera can begin with nausea, vomiting, diarrhoea and abdominal cramps. Neurological symptoms may accompany these symptoms or become more noticeable in the days afterwards.
One particularly distinctive feature is altered temperature perception. Cold water, a chilled drink or a cold surface may cause a burning, painful or electric-shock sensation. This is called cold allodynia. People sometimes describe it as hot and cold sensations being reversed.
Other symptoms can include:
Tingling or numbness around the mouth, hands and feet.
Itching, sometimes without a visible rash.
Muscle aches, joint pain and weakness.
Fatigue, dizziness and headaches.
A metallic taste or unusual tooth pain.
Ongoing food sensitivities and digestive issues.
Digestive symptoms may settle while neurological symptoms persist for weeks or months. Occasionally, symptoms last considerably longer. This fact sheet may also be of use for understanding ciguatera, its effects, and toxin prevention.
Why I ask about past food poisoning
One of my initial consultation questions is: “Have you ever had food poisoning, overseas or here in Australia? How long did it take you to recover, and do you still have any symptoms?”
For me, this is part of taking a thorough history, including when I see patients for fertility or autoimmune concerns. I want to understand what happened before their current symptoms began, particularly if there are digestive issues - a common complaint in my clinic.
What particularly catches my attention is the combination of a fish meal in a tropical location, an acute illness, and unusual ongoing sensory symptoms. That history warrants medical assessment rather than an assumption that everything is simply “gut-related” or “nerve related” as health professionals may often miss this unusual symptom correlation.
Is there natural treatment for Ciguaterra?
In TCM, some persistent symptoms following an illness may be understood through the traditional concept of a “lingering pathogen” where the effects of an illness are considered unresolved and continue to disturb the body’s balance.
Another historical concept is Gu syndrome, traditionally associated with poisoning and parasitic illness. Some contemporary Chinese medicine practitioners draw on this framework when considering complex, longstanding symptoms affecting several body systems following an illness. Gu syndrome and lingering pathogens are distinct traditional concepts, rather than medical issues however in TCM we always take this into account when treating a patient.
Unfortunately, there is currently no specific Western medicine antidote for ciguatera, nor is there good quality evidence that complementary medicine is beneficial. Medical care focuses on hydration, monitoring and managing symptoms. Suspected poisoning after eating fish needs prompt medical assessment; breathing difficulty or collapse requires emergency care. Many patients may feel frustrated at their ongoing symptoms and seek alternative medicines in the hope of relief, this is common in my clinic.
Traditional Chinese medicine focuses on symptoms and individualised treatment. tailored to the individual’s presentation. Many of the long term symptoms of ciguatera overlap with those I see in patients experiencing chronic fatigue, fibromyalgia and nerve pain or neuralgia. Although these conditions have different underlying causes (root cause) in TCM we treat both Ben (本) the root, and the Biao (標) the branch. The branches are the symptoms someone experiences, such as pain, numbness, fatigue or digestive discomfort. The root is the underlying pattern identified through an individual TCM assessment. Treatment therefore aims to ease the presenting symptoms while addressing the broader pattern, rather than using the same approach for everyone with a particular diagnosis., with the aim of easing symptoms such as pain and supporting the nervous system as well as aiding sleep and daily functioning. Clinical research supports acupuncture for pain relief in certain neuralgias, but its effectiveness for ciguatera-related symptoms still requires specific investigation.
An interesting connection with traditional herbal medicine
My interest in ciguatera led me to explore traditional Pacific remedies and their connections with Chinese herbal medicine. One herb that caught my attention was Zi Su Ye, the leaf of Perilla frutescens.
Perilla has a long history as both a food and a medicinal plant in East Asia. In traditional Chinese medicine, Zi Su Ye has been used for nausea, digestive discomfort and conditions historically described as fish or crab poisoning.
What makes the connection particularly interesting is rosmarinic acid, a naturally occurring compound found in perilla leaves.
Rosmarinic acid is also found in Heliotropium foertherianum, commonly known as octopus bush, a different plant traditionally used for ciguatera in parts of the Pacific, including French Polynesia. Researchers studying this traditional remedy found that its leaf extract and isolated rosmarinic acid inhibited the effects of a Pacific ciguatoxin in cell-based and receptor-binding assays.
For me, this is a fascinating meeting point between traditional knowledge and scientific investigation. While research does not say that rosmarinic acid can treat ciguatera this is a promising research connection.
Where does Chinese medicine fit?
In my broader practice, I have used acupuncture and traditional approaches such as cupping, moxibustion and small-volume bloodletting for presentations related to neuropathic pain and neuralgia, for chronic fatigue and fibromyalgia I might use a combination of supplements and acupuncture.
While there haven’t been any clear studies on these modalities as treatments for ciguatera, what I can say is that taking time to hear a patient’s full story, including an illness years earlier, can reveal information worth discussing.
The beauty of TCM is that we work on specific symptoms, and each person presents differently.
Acupuncture, neuralgia and ongoing nerve symptoms
Although acupuncture has not been established as a treatment for ciguatera itself, there is clinical evidence that it can help relieve pain in certain neuropathic conditions, including neuralgia.
Randomised trials have found benefits from electroacupuncture for trigeminal neuralgia and postherpetic neuralgia the persistent nerve pain that can follow shingles. Research in diabetic peripheral neuropathy has also reported improvements in numbness, although that evidence has greater limitations. Therefore, these potential benefits for nerve-related symptoms are worth exploring.
These findings are relevant to my interest in supporting people with persistent nerve-related symptoms. As with all my clients receiving acupuncture points aimed at regulating the nervous system is part of my acupucnture treatments - “You cannot heal a body that is stuck in fight or flight.” which is a core principle often attributed to Polyvagal Theory and nervous system work. This provides a basis for discussing acupuncture as an individualised option alongside medical care, while acknowledging that its effectiveness for ciguatera-related pain and altered sensation still needs specific investigation.
Why your history matters
If you have ongoing symptoms after a fish related illness, tell your doctor what you ate, where it came from and when your symptoms began. Even when the initial stomach upset has passed, that history still matters. I imagine that, with the increase in ciguatera cases reported in Australia, many doctors will become more familiar with this condition.
If you would like assistance with pain or other symptoms you are experiencing please reach out, or fill in the contact form to receive a call back.
Frances Tobeck | Acupuncturist and Herbalist | consulting in Windsor, Melbourne & Ballarat.