Mushrooms’ popularity is booming, but so are poisonings, experts warn

By CNN

Published December 29, 2023 7:43 AM

CNN

By Jen Christensen, CNN

(CNN) — Mowing the yard outside his home in Windham, Ohio, William D. Hickman discovered what he thought would make a delicious addition to his dinner. A beautiful handful of mushrooms had popped out of the shaggy green lawn.

“As I’m mowing the ditch, I go by them three or four times, and I’m like, ‘Man, those look good,’ ” the 55-year-old said, closing his eyes as he remembers the day.

For generations, the Hickman family has foraged for mushrooms. Unlike his great-grandparents, who had to study which ones were safe to eat, Hickman thought he had an advantage: He pulled out his smartphone, photographed the fungi and uploaded the image to a plant identifier.

His app said they were giant puffballs, an edible variety. So Hickman brought the little beige mushrooms inside to his wife, Tammy. She felt leery about eating something from the yard, so she sauteed them in butter and garlic and placed them carefully on his tortellini only.

Hickman thought they were delicious — until about eight hours later, when he felt like he was going to die.

He nearly did.

Mushrooms have a moment

People have been foraging for mushrooms since the Stone Age, but mycologists across the country say they’ve seen an increased interest in the hobby and a significant increase in poisonings, too.

“Fungi are kind of a hot thing right now,” said Dr. Matthew Nelsen, a research scientist at the Negaunee Integrative Research Center at the Field Museum in Chicago who is also president of the Illinois Mycological Association, a group that describes itself as “fungal enthusiasts.”

Mushroom motifs now decorate all kinds of things: tea towels, toddlers’ sweaters, table lamps. But when interest extends beyond mushroom stuffies to the real stuff, people really need to be careful.

“A lot of the calls we get are kids hand-to-mouth, but we do have adults that maybe think they know what they’re doing foraging,” said Dr. Gregory M. Mueller, who serves as vice president of science at the Chicago Botanic Garden and is a leading fungal conservation expert who consults for his state poison center. “We see they don’t, really.”

From January to October, America’s Poison Centers received more than 7,250 calls about potential mushroom poisonings, an 11% increase from all of 2022, when there were about 6,500 calls for the entire year.

This year alone, Ohio’s poison centers have had more than 260 mushroom-related calls as of October, with 45% of them going to the ER and 33 people hospitalized. In the past two years, calls to Ohio Poison Centers about potential poisonings from mushroom increased 25% from pre-pandemic levels, said Jonathan Colvin, managing director of Drug & Poison Information Center in Ohio.

Colvin said it’s not always clear whether the mushroom calls are connected to foraging, but those who have needed the most serious treatment for a liver or kidney injury reported that they had eaten foraged mushrooms that were misidentified as edible varieties.

Last year, the Hickmans made one of those calls.

‘I know this is the end’

The Hickmans went for their usual long walk after the mushroom dinner. Eight hours later, Bill started throwing up and couldn’t stop.

He had a feeling this wasn’t a typical case of food poisoning.

“You know how if you’re sick and then you feel better afterwards and you can get some sleep? Well, it just continued,” he said. There was no relief. His pain was excruciating. He felt extremely weak.

“It was awful,” he said.

When he didn’t get better, Tammy raced back to grab the mushrooms that remained in the yard. She took a photo and sent it to poison control. The workers told her that they thought her husband had eaten a toxic mushroom and that she needed to get him to the hospital right away.

It appeared that he had eaten a mushroom called a destroying angel. One mushroom has enough toxin to kill a person; Bill ate four.

When he didn’t resist going to the hospital, Tammy knew that something must really be wrong. “He’s usually very stubborn,” she said.

At the emergency room, she said, doctors effectively told her to start “making arrangements.”

“When I heard that,” Bill said, “and I knew how I felt, I thought, ‘I know this is the end.’”

Even experts struggle to identify what’s safe

Even experts can have a hard time telling the toxic from the edible just by sight, mycology instructor Rick Van de Poll said. He has to examine some of them under the microscope to be sure they’re safe.

While hiking through the crunchy leaves in Sandwich, New Hampshire, this month, his hazel eyes constantly scanned the crevices of beech and birch trees. For nearly 50 years, he has searched the forest’s dark corners for its fungal gems. Some can sell for hundreds of dollars on the international market.

One crisp day this fall, Van de Poll found at least 35 varieties within just 100 feet of a tree-lined road. Spread out on a tall table, some look like inside-out umbrellas with dark centers turned toward the sun. Others are tiny with a bright orange underside. Some are mustard yellow with a fan of dark gills.

Some are edible, and some are poisonous.

To sell foraged mushrooms in New Hampshire, people have to be certified, but Van de Poll said he has made worrisome discoveries.

“I’ve pulled toxic mushrooms off the shelves,” Van de Poll said. “We’re trying to correct that.”

He offers classes to help people identify which ones are edible, but unless it’s a general topic, he teaches only in-person. It’s too tricky to identify mushrooms online, and although apps are helpful, they should not be used to determine if something is edible, he said. Color and structure can help, but people need to use all their senses, including smell, to determine which mushrooms are safe to eat, he said.

Dr. Kathy LeSaint, San Francisco emergency room physician, said that even with modern technology, identifying an edible mushroom is difficult. She remembers all too well a period of weeks in 2016 when the Bay Area had 14 patients poisoned by mushrooms.

Not all of the cases were connected, according to the paper LeSaint wrote for the US Centers for Disease Control and Prevention, but what they had in common was death cap mushrooms. Death caps and destroying angels, like the ones Hickman ate, belong to the same genus, Amanita.

Among more than 5,000 species of mushrooms, about 50 are poisonous to humans, research shows. Death caps and related species that have the same toxin are to blame for the majority of mushroom-poisoning deaths.

In the Bay Area cases, all the patients survived eating death caps, LeSaint said, but three needed liver transplants. A child who had a liver transplant also developed permanent neurological problems.

“The cost of severe poisoning and potential death is very real,” LeSaint said.

“The thing about the Amanita species is that they don’t all look the same, which is a problem,” she said. A photo sent to an app would be from just one perspective, when all the angles need to be accounted for. “Even the books may describe a death cap one way, but it can have a spectrum of colors, and not all of them look exactly the same.”

Van de Poll, the New Hampshire instructor, said that even despite the dangers, he highly recommends foraging.

“Mushrooms have a great deal of fantastic health benefits,” he said. Research shows that mushrooms are a good source of vitamin D and are low in sodium. They may stimulate a healthy gut, support a healthy immune system, decrease your risk of cancer, promote lower cholesterol and protect brain health.

To stay safe, Van de Poll offers this advice for beginners: “Learn just a handful that you can identify very easily,” and keep consulting experts.

“Always ask somebody you trust, who knows more than you do and you think can provide a reliable and safe answer,” he said.

LeSaint, the ER doctor, said she urges foragers to always exercise extreme caution.

“We don’t want to tell them not to do it, but we always encourage people to go with someone who has some expertise in identification of mushrooms,” she said.
“Mistakes can happen, and the consequences can be death.”

An experimental antidote

Bill Hickman could have used an expert when he picked his toxic mushroom in September 2022. Because his liver and kidneys were at risk of failing, his local hospital transferred him to University Hospital in Cleveland.

Dr. Pierre Gholam, a hepatologist at University Hospital who has treated dozens of people poisoned by mushrooms, helped secure an experimental antidote.

“It’s not FDA-approved, but it seems to be very effective,” he said.

The antidote, an extract from a milk thistle plant called silibinin, needs to be delivered quickly to counter the effects of toxins on the liver.

“The earlier the better, and ideally no later than 72 hours into when you ingest the poison,” Gholam said.

Gholam has found that silibinin helps about 30% to 50% of patients, and he hopes it will be made more widely available for hospitals to have on hand. As the climate warms and mushroom season expands, and with more people foraging, hospitals may need it.

Gholam has treated 11 people poisoned by mushrooms this year. Cases came earlier than usual, he said, but there were no fatalities.

Hickman got the antidote just in time. Although it doesn’t work for everyone, it saved him.

Video of him in the hospital shows the usually fit Hickman slowly walking down the hall in his hospital gown. He drags his IV pole with him, Tammy by his side, encouraging him.

He says it took at least six months to feel more like himself physically and mentally.

He still gets choked up when he talks about it.

“There are a lot of people involved to make it happen to save me,” he said, his voice catching.

The couple was so grateful that Tammy bought the staff at University Hospital baskets filled with colorful mushroom-shaped cookies.

“For it all to come together like that was just a miracle. To me, it was just a miracle,” she said.

In the year or so since Hickman got sick, he has become even more interested in mushrooms. He sticks to photographing them, though, rather than picking them.

“I see mushrooms everywhere, and they fascinate me,” Hickman said.

A tattoo snakes up his arm, starting at the point where doctors infused him with the antidote. It ends in a drawing of four little mushrooms and the milk thistle that helped save him.

“I have more books now than I have ever had in my life about them,” Hickman said. “But I will never eat one again. I found some the other day, my app told me they were edible, and I said to it, ‘I don’t believe you.’ ”

If you are concerned that you’ve eaten a mushroom that is toxic, call the Health Resources and Services Administration’s Poison Help Line at 1-800-222-1222 or visit poisonhelp.org for additional resources.

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