Related Terms

• 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).

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. 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 health care professional.

• Conjunctivitis (eye inflammation), digestive disorders, dysentery (severe diarrhea), epilepsy, food flavoring, food uses, headache, pain relief, stimulant, ulcers, yellow fever.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

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

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

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

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

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.

1. 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. View Abstract

2. 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. View Abstract

3. 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. View Abstract

4. 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. View Abstract

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

6. 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. View Abstract

7. 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. View Abstract

8. 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. View Abstract

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

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

11. 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. View Abstract

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

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

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

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