Is Pufferfish Actually That Dangerous To Eat?

Pufferfish, also known as fugu, is well known for being a dangerous delicacy and one of the most controversial foods in the world. Yet it remains incredibly popular, especially in Japan. So, is it really safe to eat pufferfish, or should it be avoided altogether? Well, it depends on who prepares it, and even then, there is still a small risk. 

On average, roughly 50 people per year are poisoned by pufferfish. However, many of these deaths are attributed to people who have caught or purchased the fish and attempted to prepare it at home. Because pufferfish is so deadly, only specially trained chefs are allowed to prepare it in Japan, a restriction that was put in place in 1948. Under these laws, chefs must train for two to three years, depending on the city they are in, and can only take their licensing test at 20. To pass this exam, chefs must be able to identify different species of pufferfish and dissect the fish perfectly, removing the toxic and inedible parts while preparing the edible pieces into a dish. 

Since restrictions on who can prepare pufferfish have been enacted, the number of poisonings has decreased, and people rarely are sickened after consuming pufferfish prepared by a trained chef in a reputable restaurant. That said, even in the hands of a professional, there will always be a lingering risk because of how toxic pufferfish is. Does that mean you should avoid it outright? No, but even if you eat sushi like a pro, it is something to be aware of.

The reason behind pufferfish's dangerous reputation is tetrodotoxin, a type of neurotoxin found primarily in marine life. This toxin is noted to cause numbness and a tingling sensation that the experience of eating pufferfish is known for. However, tetrodotoxin isn't destroyed by heat, and it can be found in the pufferfish's eyes, blood, liver, and intestines. If these organs are nicked during preparation and allowed to contaminate the edible flesh, poisoning can occur. The toxin works by blocking sodium channels and restricting nerve signals, which can result in paralysis. If severe enough, paralysis of the respiratory system can occur, causing death. 

According to the CDC, the first symptoms upon ingestion include numbness of the mouth, which gradually spreads to the rest of the face. Sweating, headache, dizziness, vomiting, weakness, and slurred speech can follow. In the second stage of poisoning, the results of the toxin progress to cause paralysis in the limbs and eventually respiratory muscles. While there is no antidote to tetrodotoxin, stomach pumping is used in some situations to mitigate the effects, though this is only advisable up to an hour after ingestion. Otherwise, supporting respiration through hospitalization in intensive care is an option. With proper care, many patients, even those with severe toxicity, can survive with lasting effects. 

Although pufferfish isn't banned in the US, it is tough to come by. It can only be sold by licensed restaurants and is only imported a couple of times per year. Trained professionals in Shimonoseki, Japan, must prepare all imported fish, and they can only be imported by Wako International based on an agreement between the FDA and the Japanese government.