
Lychee identified as cause for mystery deadly childhood illness in India - adamnemecek
http://www.abc.net.au/news/2017-02-02/lychee-identified-as-cause-for-mystery-indian-childhood-illness/8233964
======
throwanem
For those similarly annoyed by its elision in the article, the causative
substance appears (1) to be hypoglycin A (2).

(1)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412228/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412228/)

(2)
[https://en.m.wikipedia.org/wiki/Hypoglycin_A](https://en.m.wikipedia.org/wiki/Hypoglycin_A)

~~~
perilunar
The hypoglycin inhibits both gluconeogenesis and oxidation of fatty acids,
preventing the body from using fat or protein for energy. So once their
glycogen is used up they're screwed. It's fascinating.

~~~
voidlogic
Does that mean a person in nutritional ketosis could die... ?

Background for others: Most people in keto are running on mostly fatty acids
and some ketones (for the things that can't use fatty acids) and a small
amount of glucose from gluconeogenesis for the obligate glucose tissues
(retina, small percentage of brain, etc).

If you take away the ability to use fatty acids then you have to run off
ketones, which should work, but I don't know if the body can make enough (and
maybe that is impacted too?). And if your body is using gluconeogenesis to
make your essential glucose from protein, and that is inhibited, I would think
those tissues would be in trouble (its called essential glucose for a reason).

~~~
gamblor956
Probably not. The study covers this in more detail than any of the articles,
but malnutrition was the second biggest factor in the deaths.

In most cases of sickness (and nearly all cases of death), the lychee was the
bulk of the food eaten by the child. The children were already somewhat
hypoglycemic because they weren't eating much, and due to their diet weren't
ketogenic (minimal fat or protein in their diet). When the hypoglycin blocked
the oxidation of the minimal fatty acids and protein in these children, they
eventually ran out of usable glucose, resulting in seizures.

For someone who is merely ketogenic, the hypoglycin would block _some but not
all_ of the oxidation of fatty acids, and [edit] generally would not effect
the liver production of glucose from glycogen. The amount of dietary
fats/proteins in a ketogenic diet would overcome the effect of the hypoglycin,
and someone on a normal non-ketogenic diet might not even feel any symptoms
due to the body's heavier reliance on the liver-glucose pathway.

~~~
voidlogic
Thanks for this great reply, that makes sense. Do you know if hypoglycin
interferes with the synthesis of beta hydroxybutyrate?

------
mkagenius
Can confirm as I am from Bihar, India, children eat lots of lychees in the
season (also lots of mangoes), even many adults eat just lychee the whole day
without any other meal. Seizures were considered as being possessed by demon
which explains lack of research and delay in this discovery.

~~~
oz
I'm from Jamaica, and grew up eating lots of lychees as well. Never had any
problems. Only ate them ripe. I haven't had fresh lychees in years though,
mostly now buying the canned ones in syrup from China.

The owners of lychee trees, however, had tons of issues. It's such a loved
fruit that if you had such a tree, it was pretty much guaranteed that praedial
thieves would strike. It got so bad that I remember one nurse in the community
cutting down her tree when the sight of strange men roaming her yard became
too much.

~~~
coldtea
> _I 'm from Jamaica, and grew up eating lots of lychees as well. Never had
> any problems._

What the parent says is about people eating mostly or just lychees -- out of
poverty etc. Not the general "I eat lots of X".

------
woliveirajr
Malnourished children eating a fruit (lychee) without any previous meal could
get poisoned and have a intense decrease in blood sugar levels. That make me
wonders on how many religious practices, superstitions, etc., still exists in
modern cultures, transmitted mouth-to-mouth, due to some misunderstanding of
the true mechanisms of some occurrence in the past? I can easily see that a
"children can't eat fruits without eating some cereal" could have come as
religious belief, from a long past. And it would be effective for hundreds of
children.

~~~
noelwelsh
Kosher food could be a pre-modern public health campaign. Trichinosis is a
dangerous parasite found in pork
([https://en.wikipedia.org/wiki/Trichinosis](https://en.wikipedia.org/wiki/Trichinosis))
and shellfish have their own dangers.

~~~
pbh101
PG wrote about how he considers many religions to have a culturally-
evolutionarily useful bit ('don't eat tainted pork' over time will increase
your economic growth) and a viral one, which perpetuates and reinforces the
belief.

~~~
kpil
Is pork actually worse than eating other omnivores?

~~~
pbh101
I don't know. But I don't think too many other omnivores were usually eaten:
cows, chickens, sheep, even horses are all herbivores.

To a larger point, the imprecision of the rule would have been dictated both
by customs and limitations in knowledge of the time: culture inasmuch as there
would be no need to restrict eating omnivores that nobody ate anyway, and
knowledge would dictate how precise you could be while still being safe: we
now know that pork is ok to eat, but only because we have the tools to
reliably determine whether pork is tainted, and build processes and supply
chains that minimize that. For civilizations that didn't yet have that
insight, much safer to avoid the whole thing.

~~~
yen223
Chickens are omnivores - they'll happily eat worms off the ground.

~~~
pbh101
Good point... I forgot they'll eat just about anything, including eggs. You
don't want to feed them brunch scraps, otherwise they may start poking at
unharvested eggs sitting around.

------
idiot900
One of the saddest parts of this story is that decades of confusion could have
been ended by checking glucose levels in these children at the hospital. This
is a basic standard of care but seems like Bihar is so underprovisioned that
even this simple step doesn't happen.

~~~
chimeracoder
> One of the saddest parts of this story is that decades of confusion could
> have been ended by checking glucose levels in these children at the
> hospital. This is a basic standard of care but seems like Bihar is so
> underprovisioned that even this simple step doesn't happen.

It probably did happen, but we're talking about children who are already
malnourished to begin with. Establishing a specific food as the cause of their
low glucose levels as opposed to the effects of malnutrition is not as easy as
simply checking for their glucose levels.

~~~
idiot900
This situation is easily distinguishable from hypoglycemia from starvation -
the latter unlikely to happen in non-diabetic children who spent the day
eating sweet fruit. Checking basic labs such as a blood glucose fingerstick -
as would have happened at a properly provisioned hospital - would not identify
the specific fruit but it may well have prevented these kids from dying, as
the treatment is just to give sugar.

------
zher
Here's the link to the study published in The Lancet Global Health:
[http://www.thelancet.com/journals/langlo/article/PIIS2214-10...](http://www.thelancet.com/journals/langlo/article/PIIS2214-109X\(17\)30035-9/fulltext?rss=yes)

------
Symmetry
I'm amazed at the amount of learning that people have to do in order to
survive off the flora in a new location. We're mostly spoiled in the modern
world by how much the plants we eat are transparent in the preparation needed
to eat them.

Being able to come into some new biome, figure out through trial and error
what can be eaten when and how, and then transmitting that information
reliably to the next generation is what let humans spread all over this
planet.

I highly recommend the book _The Secret of Our Success_ covering this and
several other topics.

~~~
tekoyaki
This is mostly common sense though. You need other nutrients than just sweet
fruits.

------
ramgorur
Some interesting folk remedies prevalent in the south east asia:

1\. don't eat lychee, tamarind, unripe mango in empty stomach, always eat them
after rice or bread.

2\. don't mix pineapple and milk, or don't take them one after the other,
otherwise your stomach will get sick.

3\. eating the raw batter of palmyra palm causes fever and stomach pain.

Looks like these are factual knowledge that have been gathered and retained
over thousands of years came from observed causal relationships.

------
parennoob
Looks like they were somewhat on the right track in 2011
[http://archive.indianexpress.com/news/toll-47-bihar-may-
decl...](http://archive.indianexpress.com/news/toll-47-bihar-may-declare-
mystery-disease-epidemic/809168/0):

> "A study by the Indian Council of Medical Research concluded that a toxin
> from kasaundhi trees, being transmitted to humans through insects, caused
> the disease. The trees were cut and the disease subsided. Litchi trees and
> mosquitoes present in the region should be studied for this disease,"
> suggested Shah.

~~~
Laforet
Growing up in another country where lychees are commonly eaten, most people
were already informed about the fruit's ability to cause hypoglycemia. I
remember being told off by parents and older relatives on having too many
lychees between meals but again I never heard of any cases of death either.

A casual search on the causative agent (hypoglycin) suggest its presence and
mode of action has been well studied since the 1970s, and I wonder why this
connection has not been made sooner.

~~~
KSS42
From the article :

How has this link not been made before?

The researchers said the lychee's potential toxic effects were noted in
ancient literature from China, where the fruit originates, however the
commercial lychee industry in India is relatively young and has expanded
quickly.

"This knowledge has been slow to reach certain parts of Asia where the so-
called mysterious lychee disease has been attributed to various causes (fruit
colouring, heat stroke) in Bihar, India, to an unidentified pesticide in
north-west Bangladesh and, after an exhaustive negative virological search, to
a yet-to-be-discovered neurotropic virus in northeast Vietnam," Professor
Peter Spencer and Dr Valerie Palmer wrote in a Lancet paper discussing the
research.

------
Reason077
_" Fortunately, the high cost of these imported fruits and the likelihood that
would be eaten in small quantities by well-nourished consumers, suggests there
is little reason for concern in the USA,"_

Interesting. As a kid my only experience with Lychees was the canned variety
(often found as a desert at Chinese restaurants).

But now days, fresh ones are pretty common, and you can often buy them really
cheaply at London fruit stalls: I bought a big 2kg box for £4 recently! Very
tasty and we felt no ill-effects despite gorging ourselves on them.

------
fma
When I was young I was always told not to eat too much otherwise I'd get sick.
I always thought it was some old folklore or old wives tale. I asked my dad
tonight what he knows about eating too much lychee in regards of getting sick.
Off that bat he told me it messed up your sugar level and you can die.

He said he knew it when he was young. I was amazed that my dad, as an
impoverished and uneducated boy in China would know this. A lot of people
easily discount Traditional Chinese Medicine as anecdote, but somethings
should be investigated scientifically (I'm not going to get in an argument
here about TCM, but those are my thoughts).

He also mentioned if you soak lychee in salt water you can eat more of it - I
would be curious what the scientific backing is, if there is any at all.

~~~
woliveirajr
And that's another good discussion, on how old knowledge attracts attention
from pharma companies and some try to earn patents and all sort of protections
from those "new products".

I read sometime ago about India (?) releasing lots of ancient documentation
about old medicines, as a knowledge base, exactly to protect the population
from those kind of problems.

~~~
fma
Here is a recent one:

[http://www.pbs.org/newshour/rundown/chinese-herbal-
therapy-m...](http://www.pbs.org/newshour/rundown/chinese-herbal-therapy-
malaria-wins-part-nobel-prize-medicine/)

"Tu was appointed director of Project 523 in 1969, and rather than sift
through modern chemicals for a treatment, she scanned ancient Chinese texts
for possible herbal remedies for malaria. The earliest description for the
parasitic blood disorder comes from Chinese medical texts dating to 2,700 BCE.
She found one promising candidate in a 2,000-year-old document that described
how sweet wormwood (Artemisia annua) could heal malaria."

------
mrfusion
Has anyone researched if this chemical would help diabetics or even dieters?
Obviously in smaller doses.

~~~
halflings
At the end of the article linked:

> The researchers also said there were now studies looking at how to put the
> lychee's glucose-lowering properties to good use in treating metabolic
> syndrome.

~~~
gamblor956
It's a misunderstanding by the journalist, since other articles and the study
itself expressly stated that the researchers concluded that lychee would
probably not be useful for diabetics because it doesn't address the correct
glucose pathway, i.e., the liver, from which most blood glucose is generated.
Fatty acid oxidation is the secondary pathway for glucose generation in the
body and generally isn't responsible for blood sugar spikes.

------
Hupriene
See also:
[https://en.wikipedia.org/wiki/Jamaican_vomiting_sickness](https://en.wikipedia.org/wiki/Jamaican_vomiting_sickness)

It was illegal to import canned ackee to the US for years, due to risk of
hypoglycin poisoning.

------
mrcactu5
Sorry for being too Western. I think of Lychee's something as a rarity and a
delicacy but I can find them in Chinatown.

When I was in mainland China, near Guangzhou, I remember a woman trying to
sell me lychees by the pound -- or whatever unit of measure -- if only I could
understand the price she had wanted.

If I understand correctly, these are children from impoverished regions, who
only eat Lychees? and they get a type of food poisoning?

------
overcast
Regardless of the poisoning, how does one eat nothing but a fruit the entire
day? I feel like you'd be sick to your stomach / diarrhea from that?

~~~
ageofwant
When you have nothing else to eat. Also diarrhea beats dying of hunger.

I'm not the "check your white privilege" type but c'mon...

~~~
overcast
I'm not so sure diarrhea beats dying of hunger. That's a quick way to die
faster.

~~~
jessaustin
That consideration will not be the first thing that occurs to a hungry child
with access to fruit.

~~~
overcast
Thus the problem.

------
mark-r
Anybody know why only children would be affected? Or is it that everyone is
affected, but only children die from it?

~~~
jandrese
Most likely it's a vulnerable population and also one that has trouble making
it to adulthood for a variety of reasons. It may also be that the researchers
were specifically looking at kids and didn't expand the study to cover adults.

------
woliveirajr
Dupe of
[https://news.ycombinator.com/item?id=13537877](https://news.ycombinator.com/item?id=13537877)

------
shkr
Amazed to see this one hacker news....I would be interested to find the
investigation behind this report.

"Hey are people sick at a hospital somewhere not in australia, like india ?"

"Is it the season for lychees ?"

"Was there once a scientific study where they found this fruit was not
perfect?"

"Google says so"

"Thanks I have an article to write. This will be useful for australians, and
other folks importing lychee from southeast asia"

~~~
mkmk
Usually works like this:

"I did something, and it would be valuable to me if people knew about it (or
–less frequently– it would be valuable to the world if people knew about it)."

"Let me see who I can spam about this."

"Oh look. Here are 100 people that have written something about health. Let me
send them a pitch that makes this seem mysterious and newsworthy"

Overworked reporter: "Oh man. I need to get a story in or my editor will yell
at me. I wonder what I should write about?"

Etc.

