Ackee (Blighia sapida)

Category

Herbs & Supplements

Synonyms

Achee, ackee apple, akee, akee apple, ankye, arilli, Blighia sapida, Cupania sapida, Blighia sapida, hypoglycin A, hypoglycin B, ishin, Sapindaceae (soapberry family), vegetable brain, vegetable brains.

Background

Ackee (Blighia sapida) is the national fruit of Jamaica and grows in clusters on evergreen trees. Hypoglycin A (the causative toxic substance in ackee) is contained in the aril, seeds and husks of ackee fruit, at various stages of ripeness.

The ingestion of unripe ackee for the purpose of medicinal or nutritional purposes can give rise to acute poisoning called "Jamaican vomiting sickness" or toxic hypoglycemic syndrome (THS). Adverse effects include loss of muscle tone, vomiting, convulsions, coma and death. Deaths have occurred after unintentional poisoning with ackee, and most of these deaths have occurred in small children ranging from 2-6 years-old. Only when the fruit ripens and opens naturally on the tree may the fruit be eaten; however, the membrane at the base should be removed.

Various parts of the ackee tree have been used medicinally to expel parasites and to treat dysentery (severe diarrhea), ophthalmic conjunctivitis (eye inflammation) and headache. More research is needed to make a recommendation of the therapeutic benefits of ackee.

Due to its toxicity, the importation of this fruit into the USA is forbidden by the U.S. Food and Drug Administration (FDA).

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Conjunctivitis (eye inflammation), digestive disorders, dysentery (severe diarrhea), epilepsy, food flavoring, food uses, headache, pain relief, stimulant, ulcers, yellow fever.

Dosing

Adults (18 years and older)

Safety, efficacy, and dosing have not been systematically studied in adults.

Children (younger than 18 years)

Safety, efficacy, and dosing have not been systematically studied in children.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Individuals with a known allergy or hypersensitivity to ackee (Blighia sapida), its constituents, or to other members of the Sapindaceae family should not take ackee.

There have been reports of anaphylaxis reactions to ackee fruit.

Side Effects and Warnings

Ackee is likely safe when tree-ripened and properly prepared ackee is taken in food amounts. However, individuals should use caution when consuming imported canned products. There have been numerous cases of toxic levels of hypoglycin detected in cans containing ackee fruit that were imported to the United States. Eating unripe or overripe fruit is not recommended due to potential toxicity.

Ingestion of unripe ackee fruit may cause abdominal pain, intermittent diarrhea, hypotonia (decrease muscle tone), weakness, nausea, vomiting, stupor, hemorrhages (bleeding), confusion, headache, convulsions, tachypnea (rapid breathing), tachycardia (fast heart beat), and intense itching.

Multiple cases of "Jamaican vomiting sickness," also known as toxic hypoglycemic syndrome (lowered blood sugar levels in the body), have been reported after the ingestion of unripe ackee fruit. Unripe ackee fruit may also be toxic to the brain, kidneys and liver. Coma and death have occurred.

Unripe ackee arillus (oil) may decrease the number of neutrophils in the blood and increase platelets.

Cholestatic jaundice, steatosis (fatty liver), vomiting and abdominal pain have been noted with chronic ackee fruit ingestion.

Use cautiously in patients with diabetes, liver disease, or compromised kidney function.

Pregnancy and Breastfeeding

Ackee is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

Ackee may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Interactions with Herbs and Dietary Supplements

Ackee may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar.

Attribution

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Rae Abrams, PharmD (University of Rhode Island); Ashley Brigham, PharmD (Northeastern University); Julie Conquer PhD (RGB Consulting); Nicole Giese, MS (Natural Standard Research Collaboration); Audrey Nealon, PharmD (Northeastern University); Lisa Scully, PharmD (Massachusetts College of Pharmacy); Kristopher Swinney, PharmD (Massachusetts College of Pharmacy); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Anto F, Aryeetey ME, Anyorigiya T, et al. The relative susceptibilities of juvenile and adult Bulinus globosus and Bulinus truncatus to the molluscicidal activities in the fruit of Ghanaian Blighia sapida, Blighia unijugata and Balanites aegyptiaca. Ann Trop Med Parasitol 2005;99(2):211-217.

Barennes H, Valea I, Boudat AM, et al. Early glucose and methylene blue are effective against unripe ackee apple (Blighia sapida) poisoning in mice. Food Chem Toxicol 2004;42(5):809-815.

Blake OA, Bennink MR, Jackson JC. Ackee (Blighia sapida) hypoglycin A toxicity: Dose response assessment in laboratory rats. Food Chem Toxicol 2006;44(2):207-213.

Carod-Artal FJ. [Neurological syndromes linked with the intake of plants and fungi containing a toxic component (I). Neurotoxic syndromes caused by the ingestion of plants, seeds and fruits]. Rev Neurol. 5-1-2003;36(9):860-871.

Eddleston M, Persson H. Acute plant poisoning and antitoxin antibodies. J.Toxicol.Clin.Toxicol. 2003;41(3):309-315.

Escoffery CT, Shirley SE. Fatal poisoning in Jamaica: a coroner's autopsy study from the University Hospital of the West Indies. Med Sci Law 2004;44(2):116-120.

Golden KD, Williams OJ, Bailey-Shaw Y. High-performance liquid chromatographic analysis of amino acids in ackee fruit with emphasis on the toxic amino acid hypoglycin A. J Chromatogr Sci 2002;40(8):441-446.

Joskow R, Belson M, Vesper H, et al. Ackee fruit poisoning: an outbreak investigation in Haiti 2000-2001, and review of the literature. Clin Toxicol (Phila) 2006;44(3):267-273.

Kupfer A, Idle JR. Methylene blue and fatal encephalopathy from ackee fruit poisoning. Lancet 5-8-1999;353(9164):1622-1623.

Lebo DB, Ditto AM, Boxer MB, et al. Anaphylaxis to ackee fruit. J.Allergy Clin.Immunol 1996;98(5 Pt 1):997-998.

Meda HA, Diallo B, Buchet JP, et al. Epidemic of fatal encephalopathy in preschool children in Burkina Faso and consumption of unripe ackee (Blighia sapida) fruit. Lancet 2-13-1999;353(9152):536-540.

Prince Leopold Institute of Tropical Medicine. Medical problems caused by plants. 2006;24-27.

Quere M, Ogouassangni A, Bokossa A, et al. Methylene blue and fatal encephalopathy from ackee fruit poisoning. Lancet 5-8-1999;353(9164):1623.

Sherratt HS, Turnbull DM. Methylene blue and fatal encephalopathy from ackee fruit poisoning. Lancet 5-8-1999;353(9164):1623-1624.

Ware GM. Method validation study of hypoglycin A determination in ackee fruit. J AOAC Int 2002;85(4):933-937.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.