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Ackee

Scientific Name(s): Blighia sapida, K. Konig
Common Name(s): Ackee, Akee, Aki, Arbol de seso, Arbre a' fricasser, Fruto de huevo, Merey del diablo, Pan y quesito, Pero roja, Ris de veau, Seso vegetal, Soapberry, Yeux de crabe

Clinical Overview

Use

The ackee is a major food in Jamaica. In South America, the fruit has been used to treat colds, fever, and diseases as varied as edema and epilepsy, although there are no clinical trials to support these uses.

Dosing

The ripe fruits are edible, however, the unripe fruits are toxic due to hypoglycins A and B.

Contraindications

The unripened ackee fruit is toxic, causing severe hypoglycemia often accompanied by convulsions and death.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use.

Interactions

Hypoglycemia caused by ackee may be masked in patients on beta-blockers because these suppress epinephrine-mediated warning signs of imminent hypoglycemia; monitor patients with diabetes.

Adverse Reactions

No data.

Toxicology

Symptoms of ackee poisoning include cholestatic jaundice, vomiting, hypoglycemia, convulsions, coma, and potentially death. Six to 48 hours may elapse between ingestion of the unripened fruit and the onset of symptoms.

Botany

Ackee is the national fruit of Jamaica and is widely found throughout the West Indies and has been naturalized to parts of Central America, Florida, and Hawaii. This tall, leafy tree grows to approximately 12 meters and produces fruit 2 times/year, between January and March, and June and August. Its oval, compound leaves have 5 pair of leaflets, the longest of which is approximately 15 centimeters at the tip. The plant produces small, greenish-white flowers. The red fruit pods split open at maturity, exposing 3 shiny, black seeds embedded in a white, waxy aril.Barceloux 2009, Lampe 1985, USDA 2016

History

The ackee tree was imported to Jamaica from West Africa in the late 1700s and is often grown as an ornamental.Duke 1985 Although the unripened walnut-like seeds are toxic, the ripe fruits are used in traditional island cooking.Lampe 1985 The ackee is a major food in Jamaica and is noted for its high protein and fat content.Ashurst 1971 Fresh ackee berries are available in season in markets and canned fruit is available throughout the year. Poisonings have long been associated with the use of the ackee, and published reports of Jamaican intoxications date back to 1904.MMWR 1992 In South America, the fruit is used to treat colds, fever, and diseases as varied as edema and epilepsy.Duke 1985

In the past, large-scale poisonings appeared to be limited to the island of Jamaica where they reached epidemic proportions during the winter months under the name of "Jamaican vomiting sickness."Lampe 1985

Chemistry

Hypoglycins are potent hypoglycemic compounds found particularly in the seeds and flesh of the unripe fruit. The most toxic is the cyclopropyl amino acid hypoglycin A and its metabolite methylenecyclopropylacetic acid, found in the aril and the seeds of the unripe ackee fruit.Gaillard 2011, Golden 2002 The unripe ackee fruit contains hypoglycin A at concentrations significantly higher than those in ripe ackee fruit.Gaillard 2011, Golden 2002 In addition, other hypoglycemic compounds, including hypoglycin B and other cyclopropanoid amino acids, are found in the seed. CNS active carboxycyclopropylglycines found in the unripened fruit are reported to be potent group II metabotrophic glutamate receptor agonists.Natalini 2000

Uses and Pharmacology

The ackee is a major food in Jamaica. In South America, the fruit has been used to treat colds, fever, and diseases as varied as edema and epilepsy.

Animal data

Research reveals no animal data regarding the use of ackee for any condition.

Clinical data

Research reveals no clinical data regarding the use of ackee for any clinical condition, including traditional remedy claims.

Dosing

The ripe fruits are edible, however, the unripe fruits are toxic due to hypoglycins A and B.

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use.

Interactions

Hypoglycemia caused by ackee may be masked in patients on beta-blockers because these suppress epinephrine-mediated warning signs of imminent hypoglycemia; monitor patients with diabetes.

Adverse Reactions

Because ackee has no data supporting a medicinal use, all adverse reactions are addressed under Toxicology.

Toxicology

Hypoglycin A is a water-soluble liver toxin that induces hypoglycemia by inhibiting gluconeogenesis by limiting the activity of cofactor mimics (CoA and carnitine) that are required for the oxidation of long-chain fatty acids.MMWR 1992 Methylenecyclopropylacetyl-CoA also causes secondary inhibition of gluconeogenesis by inactivating several acyl-CoA dehydrogenases involved with the oxidation of fatty acids and several amino acids.Sherratt 1986 The pink raphe (the portion of the seed that attaches to the ovary wall) and the aril in the immature plant are poisonous because of the presence of the hypoglycins. The arils become edible when the fruit ripens; hypoglycin A is efficiently removed from the edible arils when the ackee fruit is boiled in water for approximately 30 minutes.Sherratt 2002 Hypoglycin A appears to be approximately twice as toxic as hypoglycin B.Farnsworth 1971 The powdered fruits are used in Africa as a fish poison.Duke 1985

Poisoning from consumption of unripe ackee (including of roasted ackee seeds) manifests with symptoms developing within 6 to 48 hours and including GI distress, hypoglycaemia, and CNS depression. A quiescent or remission period may be followed by symptoms including lethargy, hypotonia, hypothermia, and progress to convulsions, and coma.Barceloux 2009, Katibi 2015 Fulminant liver failure has been reported,Grunes 2012 and a case fatality rate of 52% has been published.USDA 2016

Treatment is primarily supportive with restoration of fluid, electrolyte, glucose, and pH balance.Barceloux 2009

Limited experimental studies suggest a role for glycine, methylene blue, and riboflavin, as antagonists in hypoglycin A intoxication; however, no clinical data support this concept.Barceloux 2009, Katibi 2015

References

Ashurst PR. Toxic substances of ackee. Review. J Sci Res Counc Jam. 1971;2:4-16.
Barceloux DG. Akee fruit and Jamaican vomiting sickness (Blighia sapida Köenig). Dis Mon. 2009;55(6):318-326.19446675
Blighia sapida. USDA, NRCS. 2016. The PLANTS Database (http://plants.usda.gov, December 2016). National Plant Data Team, Greensboro, NC 27401-4901 USA.
Duke JA. Handbook of Medicinal Herbs. Boca Raton, FL: CRC Press; 1985.
Farnsworth NR, Segelman AB. Hypoglycemic plants. Tile and Till. 1971;57:52.
Gaillard Y, Carlier J, Berscht M, et al. Fatal intoxication due to ackee (Blighia sapida) in Suriname and French Guyana. GC-MS detection and quantification of hypoglycin-A. Forensic Sci Int. 2011;206(1-3):e103-e107.21324617
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;40:441-446.12387335
Grunes DE, Scordi-Bello I, Suh M, et al. Fulminant hepatic failure attributed to ackee fruit ingestion in a patient with sickle cell trait. Case Rep Transplant. 2012;2012:739238.23259140
Henry SH, Page SW, Bolger PM. Hazard assessment of ackee fruit (Blighia sapida). Hum Ecol Risk Assess. 1998;4:1175-1187.
Katibi OS, Olaosebikan R, Abdulkadir MB, Ogunkunle TO, Ibraheem RM, Murtala R. Ackee fruit poisoning in eight siblings: Implications for public health awareness. Am J Trop Med Hyg. 2015;93(5):1122-1123.26324727
Lampe KF. AMA Handbook of Poisonous and Injurious Plants. Chicago, IL: Chicago Review Press; 1985.
Larson J, Vender R, Camuto P. Cholestatic jaundice due to ackee fruit poisoning. Am J Gastroenterol. 1994;89:1577-1578.8079944
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. 1999;353:536-540.10028981
Natalini B, Capodiferro V, De Luca C, Espinal R. Isolation of pure (2S,1'S, 2'S)-2-(2'-carboxycyclopropyl) glycine from Blighia sapida (Akee). J Chromatogr A. 2000;873:283-286.10757305
Sherratt HA. Hypoglycin, the famous toxin of the unripe Jamaican ackee fruit. Trends Pharmacol Sci. 1986;7:186-191.
Toxic hypoglycemic syndrome—Jamaica, 1989-1991. MMWR. 1992;41:53-55.1731182

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This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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