Ep 166 Amanita poisoning: Death Cap-tivating

In forests, in lawns, in city parks across the world lurks a small, pale, unassuming mushroom whose inconspicuous appearance belies its deadly nature. For within this mushroom dwelsl one of the deadliest poisons known to humans: amatoxin. It’s because of this toxin that the aptly-named ‘death cap mushroom’ (Amanita phalloides) is responsible for the vast majority of mushroom-related deaths around the globe each year. What makes this poisonous mushroom so very deadly, and is there anything we can do about it? In this episode, we take a journey through this legendary mushroom’s story, exploring its destructive biology, its murderous history, and its worrying yet hopeful future. Tune in to learn more about these mushrooms that show death can come in small packages.

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Episode Transcript

Speaker 1 (00:00):
Just a quick content warning here. The first hand account
does include a description of the death of a dog,
and so if you would like to skip that, you
can fast forward around five or six minutes.

Speaker 2 (00:14):
Hi, my name's Diana and I had a beautiful six
month old Bernie's Mountain dog puppy named Donado, which means
gift in Italian, and he was that he was gorgeous.
In the summer of I think it was twenty ten,
I was at a friend's house in augustin Carmel Valley, California.

(00:34):
It was hot, middle of the summer, not a time
that you would think there'd be mushrooms. So we were
swimming in the pool and he was running around having
a blast, and I didn't come when I call. I
looked for him, and I found him in the garden
with what looked like was an inverted mushroom growing into
the ground. I couldn't figure out what the heck it was.

(00:55):
Little did I know that this cup like thing in
the ground was the volva of death cap mushroom. About
four hours later, he threw up, but he was still
running around in active and I didn't think much of
it because he was a puppy, but in the middle
of the night, he continued throwing up and had major
diarrhea and he was in obvious pain. So I rushed

(01:16):
him to the emergency VET in Carmel Valley at five am.
And in twenty ten, vets weren't really that aware of
mushroom toxicity as they are today. Also, it was a
bit of a perfect storm in some ways because my
high level vets that were in the Bay area were
moving their offices, so I had to stay with this

(01:37):
small country emergency VET. Though I brought the shards of
the mushroom to the vets, they disregarded them, and they
gave him some anti nausea medication and ran a liver
test initially and it was slightly elevated, but they just said, oh,
he'll get better. They kept him to watch him and
he was not improving. I could tell he wasn't and

(02:00):
I pushed for another liver test, and they kept putting
it off and putting it off, and finally late that
night they did it again and his values were off
the charts. We transferred Donato at that point to a
larger and high level VET hospital, and though they tried everything,
they couldn't save him. I was devastated. I mean absolutely devastated.

(02:22):
Had I known what I know now, you might have
had a chance. Now, yes, I can identify a death
cat mushroom in an instant. I would have induced vomiting
immediately after seeing that inverted cup in the ground. And
today vets they have a quick and easy way to
test for amatoxin poisoning developed by Candice Beaver. And also

(02:44):
I recognize that though the summer is not a time
that you think of mushrooms, when people water their gardens
and create a really nice warm environment underneath the oak trees,
you can have death cap mushrooms in the midst of summer.
So since that horrible day, it's become Donado's legacy and
my mission to spread the warning about the danger of

(03:05):
mushroom toxicity. I started a blog Mushrooms nine one one.
I've handed out over eighty thousand mushroom alert cards and
them helping you know, Candice and others to promote the
amatok test. I hope everybody stays safe out there and
watches their yard mushrooms come up quickly.

Speaker 3 (04:03):
Room.

Speaker 1 (04:14):
Yeah, yeah, that is absolutely heartbreaking.

Speaker 4 (04:18):
It is. Thank you so much for taking the time
to share your story with us for having to relive that,
and also for all the work that you're doing and
trying to raise awareness and advocacy. We really really appreciate it.

Speaker 1 (04:31):
Yeah, we truly do. Thank you. Hi.

Speaker 4 (04:35):
I'm Aaron Welsh and I'm Aaron Alman Updyke.

Speaker 1 (04:37):
And this is this podcast Will Kill You.

Speaker 4 (04:40):
And today we're talking about mushrooms, not just any mushroom.

Speaker 1 (04:44):
Right. This is our first foray into poisonous mushrooms.

Speaker 4 (04:48):
It is, and it definitely won't be our last. Because
if there's anything that I got very interested in, it
is how many different toxins there are in so many
different mushrooms?

Speaker 1 (04:59):
Yes, and like why great question? Great question. Yeah, I
think this is going to be a really interesting episode.
I am really excited to learn about the biology of
this toxin, Like what terrifying does It's scary. It's truly
so scary, and it's it's just bizarre. Like to put
that along with the ecology and the evolutionary ask for.

Speaker 4 (05:23):
The question I have, that's what I want to because
I was like not reading that and then I was like, sorry,
why does this toxin exist?

Speaker 1 (05:30):
Why is it?

Speaker 4 (05:31):
What is it doing for this mushroom?

Speaker 1 (05:33):
I know. That's my big question.

Speaker 4 (05:35):
Well I do, I know, I guess I hope you do,
because I want to know.

Speaker 1 (05:39):
We'll find out. Okay, but before and we can do
any of that, it is quarantine time, Aaron. What are
we drinking this week?

Speaker 4 (05:48):
We're drinking the deadliest dose.

Speaker 1 (05:51):
I mean it kind of is. It's like one of
the deadliest toxins on the planet.

Speaker 4 (05:55):
Yeah, yeah, yeah, yeah, as far as I know, I mean,
I guess I didn't look up all deadly talks, but
like as far as mushrooms goes, it's for sure up there.

Speaker 1 (06:04):
It might be up there. And in the Deadliest dose.
The quarantini and plasy burrita is not deadly. It is delicious.
It is. It has vodka, it has cucumber juice. How
fun is that? It has lime juice, simple syrup, and
elderflower liquor.

Speaker 4 (06:21):
Kind of like a little gimlet but with elderflower.

Speaker 1 (06:24):
Oh so good.

Speaker 4 (06:25):
You'll find the full recipe for that quarantini, as well
as the non alcoholic and equally delicious plasy Burrita on
our website, This podcast will Kill You dot com and
on our social media Are you following us yet? On
social media? We're on Instagram, We're on tick talk.

Speaker 1 (06:42):
Yeah, we are all over social media, so Internet check
us out. Do you know what else is on the internet.
Our website, our website, it's this podcast will kill You?
Dot com comprising enough. That is the name, that is
the url. And on our website you can find and
all sorts of things from transcripts to our show notes.

(07:04):
You can find links to bookshop dot org, affiliate account,
our Goodreads list, music by Bloodmobile, the incredible merch we have.
I love this shirt so much. This design is like,
it's one of my favorites. The rat queen is she
steals my heart, She's so cute, and other things. Patreon
contact us form a link to a first hand account form.

(07:27):
You know there's there's a lot of good stuff, so
check it out. Yeah, do that all right?

Speaker 4 (07:33):
Shall we get into this mushroom, Aaron?

Speaker 1 (07:36):
I think we should. Let's take a quick break and
then begin. I know you'll get.

Speaker 4 (08:16):
Into this more, Aaron, But there are well over fifty
thousand species of mushroom across the globe.

Speaker 1 (08:24):
I won't be getting into Okay, sure, diversity.

Speaker 4 (08:28):
Good because let me tell you, there are over fifty
thousand species of mushroom across the globe, excellent. Many of
these are still unclassified, unnamed. At least three hundred and
fifty of them have been identified as edible mushrooms, and
around a thousand are poisonous. Of all of these poisonous mushrooms,

(08:50):
there's a really wide variety of different toxins that they produce,
each of which has different effects on our bodies, and
yet none of them are quite as deadly as the
subject of today's episode, Amanita Filodes.

Speaker 1 (09:09):
Quick question.

Speaker 4 (09:10):
Okay, I love it when we start off.

Speaker 1 (09:13):
That's okay when you say that there are a thousand
species that are classified as poisonous or have toxins that
can be harmful. Is that too humans or mammals specifically,
or is that like that's a great question.

Speaker 4 (09:28):
I think that is from a human context. Okay, but
I don't know they're sure. Yeah, it was like a
review paper.

Speaker 1 (09:33):
Right, I mean, if it's like edible versus poisonous, Yes,
I could see that being.

Speaker 4 (09:37):
For humans anthropocentric. Okay, yeah, Amanita Filodes or the death
cap mushroom. I want to paint us a picture here,
because I don't know, most people probably aren't that into mushrooms.

Speaker 1 (09:51):
I think you might be wrong about that, but well.

Speaker 4 (09:53):
Okay, I probably am. I'm not that into mushrooms, so
I needed to paint myself a picture of what we're
talking about here. And as far as mushrooms go, I
feel like when I first looked at the pictures of
Amanita filoids, it looks pretty innocuous. It was like a
mushroom looking mushroom. Like, draw a picture of a mushroom, kid,
you're gonna get something that looks a lot like Amanita.

(10:16):
So it has this very kind of gently domed cap
with this wide brim, okay, and looks a lot like
like the mushrooms in Fantasia, with maybe a less pointy dome.
Do you remember those dancing mushrooms in Fantasia?

Speaker 1 (10:32):
Which which music or which act?

Speaker 3 (10:35):
Like?

Speaker 1 (10:35):
What else was going on with the mushrooms? I remember
like the Dino one very strongly.

Speaker 4 (10:40):
And remember the mushroom one and then the dancing brooms,
And I don't know if that was the same skit, right, Okay, no, okay, Well,
then think of the Toad mushroom in Super Mario Brothers.

Speaker 1 (10:53):
Toad. Oh yeah, okay, Toad, Sure, okay, Toad, let's do that.

Speaker 4 (10:56):
So Toad is a red with white dot mushroom that
is also an amanita species, Amanita muscaria. Okay, so Amanita
fhiloides looks kind of similar to toad except that the cap,
instead of being red with white dots, is this light
kind of yellowy green, almost metallic looking, like very smooth cap.

(11:20):
They can be quite large, so we're talking. The cap
is like between five to fifteen centimeters in diameter, which
is like two to six inches across, so pretty good size.

Speaker 1 (11:29):
Wow.

Speaker 4 (11:30):
And then on the underside, of course, mushrooms have gills,
and in the case of Amanita filoides, they're white, pure
white gills. And then underneath on their little stock or stem,
which I learned in mycology is called a stipe, just
to be fancy. Along this stipe, they have a frilly,
little like mini skirt that hangs down just below the

(11:53):
cap and their stipe. Their stem is pretty beefy looking
compared to some other species of Amanita, so they're like
a little thicker and they can be pretty long, like
three to five inches tall. Coming out from the ground.
It's a white stem but with some little olivy kind

(12:14):
of scaly bits that you might see on there. And
then just below like buried, just beneath the earth where
this mushroom is coming out, but often visible if you
were to pull this mushroom all the way out, they
have this wider, swollen, like sock sack looking situation that
hangs down. It's called a volva, not a volva, but

(12:37):
a volva volva Okay. It looks almost like, i don't know,
like a really fragile eggshell that the mushroom is like
growing out of.

Speaker 1 (12:47):
And that is kind of what it.

Speaker 4 (12:49):
Is, because when these mushrooms come out of the soil,
they first come out in what's called this universal veil,
and then the mushroom kind of pokes out of it.
All amanita spe do this, and so you know, on
the red and white I'm getting a little too detailed
there in but sorry.

Speaker 1 (13:05):
I'm loving it.

Speaker 4 (13:05):
The red and white mushrooms, the white little dots are
remnants of that universal veil.

Speaker 1 (13:10):
Oh, how fun isn't that cute?

Speaker 4 (13:12):
And so other species of Amanita have maybe like a
big chunk of it kind of left on top of
the cap Amanita filoids doesn't have any left on the top.
The frilly skirt that hangs down on this stipe is
part of it, and then it has this eggshell sack
at the bottom. Okay, okay, So that's to paint a picture.

(13:33):
Google image search also, and I know we'll both probably
talk a little bit more about the distribution and range,
but to continue to set the stage, this mushroom, what
it is is the reproductive part of a fungus, So
it's also called the fruiting body. And it's just the

(13:54):
part of this fungus that's visible above ground, but beneath
every mushroom. There's a lot more to the fungal organism
than meets our little eye. And in the case of
the death cap, this mushroom is one part of what's
called an ecdo michael rhizal fungus, which is a fancy
way of saying that this fungus makes its home via

(14:16):
a symbiotic relationship with the roots of a bunch of
different tree species. So in order to grow, it has
to have certain tree species around it that it makes
its home with. So while it's native to Europe, this
mushroom has spread to essentially the entire globe, with the
exception of Antarctica. It's in Australia, South America, Africa, Asia,

(14:39):
and North America everywhere. Yeah, and it is the most
deadly mushroom to humans that we know of. There are
three main toxins, or like classes of toxins that are
present in Amanita filoides. There are amatoxins, hollotoxins, and verotoxins.

(15:03):
But today we're only going to focus on one of these,
and that is the amatoxins. The reason is that the
phallotoxins and the verotoxins, while they exist and they are
toxic to cells in vitro to various degrees, they're mostly
not absorbed by our guts, and so they don't really
contribute to the toxicity of these mushrooms, at least in humans. Okay,

(15:24):
so we're just talking today about amatoxins. This is a
group of toxins. They're called like in terms of what
their chemical structure is. They're like a little ball of
a protein. They're called cyclic octapeptides because they're eight amino
acids and they form two little rings. And because of

(15:47):
the shape of these toxins, they're pretty heat stable, so
they're not degraded very substantially in the process of say
cooking or drying them rying. And there's a wide variety
of amatoxins. It's not just one, but the primary one
that is especially deadly in death cap mushrooms at really

(16:07):
high concentrations is called alpha amanotin.

Speaker 1 (16:11):
I think that's how you say it.

Speaker 4 (16:14):
And let me tell you how deadly this particular toxin is.
The lethal dose for humans can be as low as
point one milligram per kilogram of body weight.

Speaker 1 (16:28):
It's wild. It is wild.

Speaker 4 (16:31):
So that means six to eight milligrams of this toxin,
which is like, that's how much.

Speaker 1 (16:35):
I don't know.

Speaker 4 (16:36):
A teaspoon of salt weighs like between five and ten milligrams,
depending on the brand. So we're talking about like a
tea spoon can kill a grown adult human that weighs
between sixty and eighty kilograms, which is one hundred and
thirty to one hundred and eighty pounds.

Speaker 1 (16:50):
And how much is in a mushroom?

Speaker 4 (16:51):
I knew you were going to ask how much is
in a mushroom? It can vary, of course, and just
like with other plants that we've talked about, it's going
to depend if we're talking about the cap, the gills,
the stock, et cetera. But on the low end, the
average estimate is about zero point two milligrams per gram
of mushroom tissue, and a whole mushroom of this species

(17:12):
might weigh like one hundred grams, so that's like twenty
milligrams in an entire mushroom. Twenty milligrams. That's more than
double what it would take to kill a human being.

Speaker 1 (17:21):
Yeah, so a half a mushroom is half a mushroom.

Speaker 4 (17:24):
Wow, I know it's terrifying. Now. Aminita filoides is by
no means the only mushroom that makes this toxin or
any of the other amatoxins, because there are others that
are very deadly as well. There are lots of other
species in this genus that do, and some of them
have equally terrifying names, like the destroying Angel or the

(17:48):
springtime destroying Angel. And there are also a couple of
other genera to Galerina and Lepioda. I might be pronouncing
those wrong. And all of these can sometimes look very
very similar to and be confused for edible mushrooms or
psychogenic mushrooms, so it's very easy to confuse both the

(18:08):
deathcat mushroom and other similarly toxic mushrooms for things that
you might want to ingest. So then the question is
what is this toxin actually doing to our bodies? Like,
why is it so deadly? This protein, it turns out,
blocks transcription.

Speaker 1 (18:30):
That's not a good thing.

Speaker 4 (18:31):
It's not a good thing. And for anyone who's like,
I'm sorry, that's two technical of a biology term, let
me tell you what that means.

Speaker 1 (18:38):
It means that it.

Speaker 4 (18:39):
Blocks the process by which our cells are making proteins.
So we our cells like their job, our job of
our cells is to make proteins to be able to
do I don't know, life, and so this toxin blocks
a fundamental step in the process that all of our
cells have to be able to to do. And when

(19:01):
that happens, our cells stop being able to metabolize, and
that then sends out signals that induce apoptosis or programmed
cell death. So this toxin doesn't It is called a
cytotoxic toxin, Like that's the classification of it. But it's
not super directly killing our cells. It kills our cells

(19:22):
by making them nonfunctional, and then our body kills off
those non functional cells. And yeah, and it does this irreversibly,
so it irreversibly binds to a protein that blocks transcription
and makes it non functional.

Speaker 1 (19:36):
Can I ask what that protein is?

Speaker 4 (19:39):
It's RNA polymerase too.

Speaker 1 (19:41):
If eactly want details, I actually do.

Speaker 4 (19:45):
Yeah, yeah, RNA polymerase too, So yes, okay. So it's
like that's pretty bad.

Speaker 1 (19:50):
Yeah, it's like, not only does it just shut it down,
it shuts it down and then marks it for destruction
exactly exactly.

Speaker 4 (19:58):
And because this is a really small protein toxin, it
can and does travel via our bloodstream after it's absorbed
in our gi tract to pretty much anywhere in our body.
And we do not have any enzymes, any machinery to
inactivate this toxin. We do not metabolize it, We don't
break it down into something less harmful. All that our

(20:22):
bodies can do is try and get rid of it,
and we do that via our kidneys. So our kidneys
filter it out and they do, bless our glomary lie
a phenomenal job of it, but they sustain some pretty
significant damage in the process, and they can't filter all
of it out. So when we ingest this toxin, it

(20:45):
gets absorbed really rapidly through our gut wall into our
bloodstream like within a couple of hours it's at peak concentration,
and within a few days, about seventy five eighty five
percent of it is filtered out through our kidneys, but
the rest of it goes to our liver, and our
hepatocytes or our liver cells are some of the main

(21:08):
sites of damage. And part of this is because what
happens is that this toxin can be sequestered into our gallbladder. Ooh,
so a quick I know you probably have questions, but
a quick anatomy lesson before that. Your gallbladder is this
separate organ that's like a storage bag that sits in

(21:30):
almost like a little pocket nook in your liver, and
it holds bile, which is a juice that your liver
makes and your liver has to secrete into your intestines
to help it digest fat. But it's stored in your gallbladder,
so your liver makes it, pooches it into your gallbladder,
your gallbatter holds it and then squeezes to release that

(21:53):
bile into your intestine when you need it. So as
this toxin makes its way into our liver, it hitches
a ride kind of on our bile and then hangs
out in our gallbladder, and then every time a person
eats a meal or just like exists, because your gallbladder

(22:15):
is still secreting, this toxin can be squirted out into
your intestine, be reabsorbed, find its way back into the liver,
and cause more damage, be resequestered into the gallbladder, be resecreted,
et cetera, et cetera, et cetera, in a process that's
called entero hepatic recirculation.

Speaker 1 (22:35):
Oh my god, So it just hangs out. It can
just keep doing its thing over over and over again,
and little do you know, you feel really bad, you barf,
you poop, whatever, and then you're like, oh, I'm starting
to feel better, I'm going to eat some more, and
it's there, and it's there, hiding in your gallbladder exactly.

(22:55):
That is I hate to anthropomorphize sinister, but yeah, it
is what I will.

Speaker 5 (23:02):
Yeah.

Speaker 4 (23:20):
And so that, Aaron, you kind of bring up the
good point of then what does this actually look like
in terms of the symptoms. What do we see then
this toxin we know is causing this damage, what does
it look like? Yeah, it's really really awful. The symptoms
of death cat poisoning of amatoxin poisoning follow a three

(23:42):
phase course, four phases really, because the first phase is
usually called this latent period. And the latent period is
that a lot of times we think of if something
is going to be toxic when you ingest it, you're
going to feel those effects right away. Right you eat
bad potato salad, you start bar from that staff ariostoxin
right away, but not the case with amatoxins. The latent

(24:08):
phase is anywhere from six to twenty four or more
hours before phase two, or the symptomatic phase starts. So
after a period of several hours, people will start having
first a gastrointestinal phase, and this is really intense vomiting,
abdominal pain, diarrhea, and this diarrhea can be so severe

(24:32):
that it's often described as cholera like, which is a
throwback all the way to season one, So if you
don't remember, cholera causes such frequent and like purely liquid
it's described as rice water stool, such severe diarrhea that
people die of dehydration very rapidly, and that is a
possibility here. So people can have such severe diarrhea that

(24:54):
they go into hypovolemic shock, from how much liquid they're losing.
Their blood sugar can dip really low because it's not
just doing this to your GI tract, it's again affecting
your liver and so it affects your glycogen stores, which
can then cause you to have really low blood sugar.
And this GI phase can last for usually like a

(25:16):
couple of days, so one to two days. But it's
very easy at this point to entirely miss the fact
that this came from a mushroom poisoning, right because there
was a delay between when you ate that mushroom, if
you even knew what you were eating, and when you
had symptoms. And this is non specific, it could look
like so many other acute gastrointestinal illnesses.

Speaker 1 (25:40):
Okay, I have a quick question about sort of like
the timing of symptoms showing up. Yeah, it's not like
a dose response thing. And okay, so then are there
is there any relationship between the structure of the toxin,
whether it's like protein or something else, and how quickly

(26:01):
those symptoms emerge or is it primarily about sort of
the target of those toxins.

Speaker 4 (26:08):
It's a really good question. I really really tried to
understand and like answer find an answer to the question
of like why exactly is there such a delay in
the symptoms, and I don't I still don't really understand
because this toxin, it's a small protein toxin. Most toxins

(26:28):
are proteins. It's absorbed very rapidly from our gi tract,
so you can detect it in the blood within a
number of hours, and then, like I said, pretty quickly,
our kidneys start excreting it. Right, They're working really hard,
and they're excreting a lot of it within that first
couple of days. From everything that I've read, it seems

(26:48):
like this toxin it's damaging cells in our liver, in
our kidney, and in our GI tract. But because of
the fact that it is pausing transcription, blocking ourselves from
doing their job, and then causing damage where those cells
are essentially dying and killing themselves from apoptosis, it's not

(27:13):
like an immediate effect, if that makes sense, So like
it takes some time. And then on top of that,
as we'll see, as this continues to progress, the whole
enterohepatic recirculation starts to happen. That really ends up kicking
the crap out of the liver. It still doesn't, in
my view, at least like very satisfactorily answer that question

(27:36):
of like why exactly is it such a long delay,
because it can sometimes be like twenty four hours, forty
eight hours. Some of that probably does have to do
with the dose, right, the more that you're exposed to,
probably the earlier on that you'll have symptoms. But it's
still going to be at least six hours delayed usually, Okay,
So it's just I guess how long it takes for

(27:57):
you to start seeing the damage to yourselves. Yeah, and
then after that you enter this phase that is very
scary because it's a false recovery phase, and that is
where these abdominal symptoms start to subside, but the damage
is really only just beginning because that toxin is continuing
to attack the liver, and this then manifests as really

(28:22):
highly elevated liver enzymes, So your liver cells are literally
just bursting open and leeching out their contents, and within
three to five days of first ingesting these mushrooms, you'll
enter phase four, which is fulminent liver failure, so enzymes
that are supposed to be contained in your liver are
now circulating throughout your bloodstream. Your liver essentially just isn't working.

(28:46):
And as we've talked about before on this podcast, your liver,
it's a very important organ, and when it stops working,
it means that you can't make clotting factors, so you
can't clot your blood, so you'll start bleeding internally. As
this continues to recirculate, you start to see additional damage
to your kidneys. You'll see severe metabolic derangements, which means

(29:08):
your electrolytes aren't normal. Your liver is just non functional
and without treatment, and in a lot of cases, when
it progresses to this point, the only treatment is liver transplant.
Then death is almost certain, which can sometimes be anywhere
from six to ten days after that mushroom was initially consumed.

Speaker 1 (29:32):
Wow.

Speaker 4 (29:33):
Yeah, for dogs, as we heard in our first hand
account and dogs, we don't have great numbers and like
how much more commonly they're affected, but certainly they're much
more likely to be eating mushrooms in a forest than
a human. The process is very similar, but it tends
to happen on a much more rapid timescale. So we're
talking about all of this happening within a period of
a couple of days rather than a week or more.

Speaker 1 (29:54):
But the symptoms still takes six hours to show up.

Speaker 4 (29:57):
Not necessarily six, but they still are delayed by a
number of hours usually. Yeah. So yeah, that's the kind
of full on course of this.

Speaker 1 (30:06):
It's it's awful, it.

Speaker 4 (30:09):
Really is, and it's I can't underscore just how severe
it is. Like, if this progresses to the point of
liver fulminent liver failure, there isn't anything you can do
except liver transplant.

Speaker 1 (30:20):
Yeah, because of just it's.

Speaker 4 (30:21):
It has irreversibly killed so many of your liver cells
at that point. There are things that can be done
before it gets to that point, and so early identification
is incredibly important, like knowing that this is amatoxin poisoning
is super important. And while we don't have all that
much in the way of highly specific treatments, like we

(30:43):
don't have an antidote, there is a lot that we
can do in terms of supportive care. And so that
includes like really aggressive IV hydration, because that is trying
to help your kidneys flush out as much of this
toxin as it can while also protecting the kidneys from
damn image from the toxin. And then there's some really

(31:04):
interesting medicines that we use, some of which don't have
a lot of data but are still used because they
are easier medicines to get, and some of which have
more data, but at least in the US, are not
approved by the FDA for use, so they're hard to
come by. But the idea behind all these medicines is
to help protect the liver and block the toxin from

(31:26):
entering liver cells.

Speaker 1 (31:28):
Got it.

Speaker 4 (31:29):
So one of the big medicines that's used is actually
comes from milk thistle, the milk thistle plant. Yeah, it's
called sillibinin I think is the compound, okay, And it
basically it binds to something on our liver cells that
then blocks the toxin from entering. So if too much
of that toxin has already entered and damaged your cells,

(31:51):
then it might not be that helpful. But because we
know that that recirculation process means that more and more
toxin is being introduced to your liver cells, like over
and over and over again, this can basically stop it
from ever getting into the cells. In the US, this
medicine is not licensed for use, but there was a

(32:13):
big clinical trial of it and so like through that
clinical trial, a lot of people did get access to it,
and it seems like, I don't know, maybe it will
be approved sometime soon, but it.

Speaker 1 (32:21):
Is used really widely throughout Europe. Okay.

Speaker 4 (32:24):
And then there's a few other medicines like penicillin or
nacetyl systeine or knack that are used for a similar
like with a similar theoretical effect, but the data just
isn't as strong that they're actually that helpful.

Speaker 1 (32:37):
Penicillin, I know, penicillin.

Speaker 4 (32:39):
G ivy penicillin. Yeah, it's it's like thought that it
maybe helps is again, the data is not great, right
or on that, but it's like let's do something, right yeah.

Speaker 1 (32:48):
Yeah, sure, And I imagine too that there's not, like
you said, it's hard to come by clinical data because
there are fortunately relatively few cases exactly.

Speaker 4 (32:59):
This is fortunately still rare, which means that it's hard
to do large clinical trials, which is a good thing,
right right. But yeah, and then other than that, then
treatment also focuses on stopping that gallbladder from contracting and
dumping out more of that toxin. So sometimes even people
will put a tube into the gallbladder to drain the

(33:20):
bile or use a medicine that helps just like stop
contraction overall and like not let people eat for a
number of days to really just kind of slow that
whole process down.

Speaker 1 (33:31):
Question answer. A lot of people have had their gall
bladders removed. Do we know anything about amatoxin poisoning in
people with their gall bladders?

Speaker 4 (33:42):
I do not, But what an interesting question. No, I
didn't see anything about that, probably because the numbers again
are like how you It would be an epidemiological like
retrospective study.

Speaker 1 (33:55):
Yeah, that's a.

Speaker 4 (33:55):
Really interesting thing to try and look at, like the
clinical course of people who are post gallbladder removal and
then unfortunately exposed versus not one an interesting I did
not see that anywhere.

Speaker 1 (34:07):
I mean, I would love to do an episode on
the gallbladder, which.

Speaker 4 (34:10):
We said that very recently erin I know, but when
when did we say it?

Speaker 1 (34:14):
I was just thinking this sounds familiar to me.

Speaker 4 (34:16):
I don't know, I don't remember, but yeah, I think
it was.

Speaker 1 (34:19):
When I asked you to describe all the parts of
the well. That was oh, maybe not then, I don't know,
maybe it was.

Speaker 4 (34:27):
I don't know, someone listening is gonna be like you guys,
it was so obvious we've reported a lot recently.

Speaker 1 (34:33):
Okay, hard to straight, I.

Speaker 4 (34:36):
Know, I know, the gallbletter is really interesting. But yeah,
that's a great question whether I mean, theoretically, yeah.

Speaker 1 (34:41):
It should be. It should be you would get.

Speaker 4 (34:44):
Less of that enterohopatic recirculation, So theoretically that should be protective.
Does it mean that you're not going to get sick? No,
but should it be protective against liver failure? Potentially theoretically interesting? Yeah,
But that is the tearifying amatoxins present in Amanita filoides

(35:05):
or the death cap mushroom Aaron.

Speaker 1 (35:07):
Terrifying is right?

Speaker 2 (35:08):
Why?

Speaker 4 (35:09):
Why? Why on Earth does a little mushroom growing on
tree roots in the forest need to have a toxin
that can kill us so easily at such high concentrations
in its tissue.

Speaker 1 (35:25):
I mean, you know what, we always say, that's a
great question, do I know? Let's find out after this break,
can't wait.

Speaker 2 (36:09):
Erin.

Speaker 1 (36:10):
I swear that one of these days my search history
for this podcast is gonna put me on some kind
of watch list if I'm not already on one. To illustrate,
I'm going to read you a really long quote that
I came across when doing research for this episode. Can't
wait ready quote four murderers only. I'm sorry. I'm telling

(36:36):
you this is published in an academic journal. Let me
just say that.

Speaker 4 (36:41):
Okay, keep going, I'm sorry for interruption.

Speaker 1 (36:43):
Four murderers. There is only one kind of mushroom worth considering.
Oh my god, Amanita Filoidy's. From the murderer's point of view,
the deadly Amanita sufferers from one shortcoming. An occasional victim,
days or weeks or even months of shattering illness, slowly

(37:05):
recovers and returns to circulation. Oh my god. True, he
is only a frail replica of his former self, but
he is alive and has foiled the murderer's coup. What journal, Aaron,
Oh there's more? Can I I need to keep you
don't know this. On the other hand, if the murderer

(37:28):
also hates his victim, and if success attends his undertaking,
his worst instincts and hopes will have been more than
satisfied by the slow progress and horrible suffering that attend
the victim's downward course into the grave. Oh my god.
The symptoms of poisoning by the deadly Amanitas are distinctive, dramatic,

(37:49):
and terrifying, and there's there's more. I just I'm gonna
keep going, keep going, keep going. Nothing arouses suspicion as
the greedy diner consumes his fateful dish, nor does he
suspect anything For many hours thereafter, the victim goes about
his affairs blissfully, unaware that the fingers of death are

(38:11):
entwining him. Perhaps he speaks with relish of the mushrooms
he has eaten, and may ask for another helping of
the same kind at the next meal, if they have
been served to him intentionally. His murderer standing by eyes
him with wicked and dissembled solicitude, alert for the inevitable
moment of a sudden the victim is gripped by appalling

(38:32):
abdominal distress, followed by vomiting and diarrhea. Neither emetics nor
purgatives can help him now, for his system has absorbed
the venom during the long period of silent invasion. End quote.

Speaker 4 (38:49):
What I need to know?

Speaker 1 (38:50):
Okay, So, like I said, from an academic publication, not
a murder mystery novel, not a handbook on how to
murder someone with, although it kind of reads like that.

Speaker 4 (39:01):
Right, It's from how to get Away with Editor.

Speaker 1 (39:03):
Yeah, sorry, that's worst show. Yeah. It's from a nineteen
seventy two article in Harvard's Botanical Museum Leaflets titled the
Death of Claudius or Mushrooms for Murderers. I are Gordon Wahson, Harvard.

Speaker 4 (39:21):
Okay, okay, seventies though traventies sure. Yeah. I also just
want to say I'm just interrupting here. This researching this
episode has made me I will now never not ask
someone with diarrhea, have you eaten mushrooms?

Speaker 1 (39:41):
Yeah? Like I well in California. I mean, I guess
southern California.

Speaker 4 (39:45):
Souning California less, but I like I I've never asked
someone that. I ask always like have you eaten anything
new or different?

Speaker 1 (39:53):
Have you traveled anywhere?

Speaker 4 (39:54):
Like I ask about food exposures obviously, but never have
I specifically asked mushrooms. I asked NICs, I don't ask mushrooms,
And now I will always be asking about mushrooms.

Speaker 1 (40:04):
Well, especially because I feel like if you have eaten
mushrooms before, and you may not think that you're eating
something new or different, when in fact it is a
new and different species.

Speaker 4 (40:13):
Right or like deadly I I have I have fear.

Speaker 1 (40:20):
Yeah, I empathize, I feel similarly.

Speaker 4 (40:23):
Oh but keep going there.

Speaker 1 (40:24):
Yeah, Okay, So this article by Wasson is not meant
to offer a murderer's perspective on Dudley mushrooms maybe, but
rather seemingly to go through one of the most famous
instances of mushroom murders in history, that of the Roman
emperor Claudius the first what yep, which is one of

(40:47):
the many historical poisonings that contributes to the lore and
notoriety surrounding this fungus. So what I want to do
today is first take us through that lore, like what
historical deaths have been attributed to this mushroom, and then
go into the very real threat that they post today
as they continue their spread, before trying to get at

(41:08):
the center of the question why why why do these mushrooms,
as you asked, possess this extremely deadly quality? Does it
serve an evolutionary purpose?

Speaker 4 (41:21):
Does it?

Speaker 1 (41:22):
For now, back to Claudius. Okay, Claudius was an unlikely emperor.
Even though he was born in ten BCE into the
ruling family of the Roman Empire, he was not close
in line of succession and the circumstances of his birth.
He was born at thirty two weeks in ten BCE, right, yeah,

(41:44):
as well.

Speaker 4 (41:44):
As accurate was dating back then, though, I don't know.

Speaker 1 (41:47):
I do feel like for some reason, I don't know
why I got this idea, but I feel like his
life is pretty well documented.

Speaker 4 (41:53):
Yeah, it's just fascinating that, like thirty two that's very specific.

Speaker 1 (41:58):
Right, How did they date? How did they date? Yeah?

Speaker 4 (42:01):
Yeah, yeah, yeah, pregnancies yea.

Speaker 1 (42:02):
Anyways, anyways, but he also had poor health during childhood,
which included a limp, a movement disorder, and quote unquote
disfigurement whatever that meant. And these things led most people,
including Claudius himself, to believe that he would spend most
of his life behind the scenes, which is what he did,
becoming a historian and a politician until a series of chaotic,

(42:26):
despotic events and assassinations made him emperor in forty one
CE at the age of fifty one, skipping over his
time as emperor you can read more about that in
books and Wikipedia, and jumping instead to his death at
the age of sixty four in fifty four CE, as
told in the form of a modern medical case report.

(42:50):
This is great Okay quote case presentation. In October, a
sixty four year old man developed post prandial abdominal pain
and vomit. He had been feeling well until passing out
during a banquet at which he had consumed a large
quantity of wine and food. One dish that was composed
of mushrooms was a long time favorite. On regaining consciousness,

(43:13):
shortly thereafter, he complained of severe abdominal pain. He vomited
and felt somewhat better. A physician induced additional vomiting by
placing a feather in the back of the patient's throat. Short, yeah,
sounds absolutely horrible. Shortly thereafter, the patient's condition deteriorated. He
became confused and exhibited signs of unremitting abdominal pain and

(43:34):
fecal incontinence. He died twelve hours after the onset of
his illness end quote. Many writers, both modern and ancient,
have attributed Claudius's death to Amanita Filoid's the death cap
mushroom allegedly sneaked onto his plate by his fourth wife, Agrippina,
who wanted to make sure that her son Nero, Claudius's

(43:55):
step son would succeed as emperor. Rather than Claudius's other son,
Britann from a previous marriage. Oh my gosh, I know
it's so dramatic. Now, was it actually murder? Could be?
There's motive, there's opportunity, there's knowledge of the deadly power
of death cat mushrooms, which I find fascinating. The symptoms
match for the most part. Kind of the account written

(44:18):
closest to his death describes it as murder, open and shut.
But there are some holes in this theory. Most of
the accusations of murder came out years after Claudius died
and are kind of just repeating rumors, you know, like
where does the source actually come from? Depending on the source,
the timeline doesn't really fit, Like did he get sick

(44:40):
at the banquet right after eating mushrooms and then die
shortly after or was it a while after he ate
them that he started having these symptoms?

Speaker 4 (44:47):
Right, and like death in twelve hours. It's like pretty,
it's pretty, it's pretty bapid.

Speaker 1 (44:52):
Yeah, And finally, I'll just say that one common way
to discredit powerful women back in the day was to
call them a poison Today it's train wreck and ancient
rome it was poisoner in any case, we probably aren't
going to ever fully resolve whether Claudius was assassinated via

(45:13):
mushrooms or died of cardiovascular disease, which is another hypothesis. Okay, yeah,
we're just like something else.

Speaker 4 (45:21):
Yeah, like some other I'm not convinced it was Amanita
by the description that I know a case report, but.

Speaker 1 (45:29):
I mean twelve hours. The other thing, though, is that
there was another account of Agrippina's son Nero is saying, oh, yeah,
my mom killed him, you know, like all these sorts
of things.

Speaker 4 (45:38):
So it's like, you know, I don't know, we weren't there,
you know, who was when.

Speaker 1 (45:47):
But the influence that Claudius's death has had on deathcap
mushroom war is indisputable. Wow, I love that. I know,
he's any paper that's like the history of death cap mushrooms,
it's like Claudius, Okay, and he's not the only one.
As the author of that murder article puts it, this
is what I'm calling it. Quote. Mycologists are prone to

(46:09):
exaggerate the importance of mushroom poisonings in history. In their writings.
We repeatedly find a list of eminent persons who have
died allegedly from eating poisonous mushrooms, a list that they
copy from each other without verification, and gosh, such shady,
I know. So rather than making the same mistake, I'm

(46:34):
just going to go through a few more famous cases
that seem to be more or less like they have
more support. I guess I'll say that I love that.
Starting with another Roman emperor, the Holy Roman Emperor, Charles
the sixth quote on the tenth of October seventeen forty
at night, his complaint was increased by indigestion occasioned by

(46:55):
a dish of mushrooms stewed in oil, of which he
ate voraciously.

Speaker 2 (47:00):
Quote.

Speaker 1 (47:01):
Ten days later he died, and his death as the
last male Habsburg of royal Austrian dynasty set off a
continent wide war, the War of the Austrian Succession. When
Charles's daughter Maria Theresa said she had the right to
succeed her father, but some countries wouldn't accept her as
a woman, right. Yeah, wow, No, It's interesting to me

(47:22):
that no one suggests that he was murdered, but more
just that he ate a bad batch the wrong ushroom,
mistaken mushroom identity. Yeah, and I'm no War of the
Austrian succession historian. I was kind of planning on reading
a book about it, and then I was like, what
are you doing? Like you have you don't have the
time for this, but it seems like a big deal

(47:44):
from what I gathered. Yeah, as Voltaire put it, quote
a pot of mushrooms changed the history of Europe. Wow, okay,
big deal, big deal. The next murder by mushroom story
I'm going to tell comes to us from France. In
the early twentieth century. A man named Girard, together with

(48:04):
his wife and mistress love It, they dreamt up a
really quite sinister insurance fraud scheme. So he would befriend
wealthy individuals or couples and then take out insurance policies
in their names, with either himself or his wife or
mistress posing as the future victim on the policy. Oh wow.
So then he would invite them over to dinner and

(48:26):
serve them deathcap mushrooms. He also apparently tried with anthrax
and typhoid, but Amanita Filoid's was his favorite fass preferred.
When his victims died, he would collect on the policy
so he would show up. I mean, this was like
the early nineteen hundred, so he would just like show up.
You could just do that.

Speaker 4 (48:47):
I guess, yeah, yeah, yeah, I don't know insurance history.

Speaker 1 (48:51):
Things didn't always go as planned. He didn't collect the
mushrooms himself, but instead hired a local guy named Theo.
Theo wasn't the greatest mycologist and sometimes collected non toxic lookalikes,
so Girard's victims just went away well fed instead of poisoned.
But eventually Girard's greed proved to be his downfall. He

(49:14):
took out four insurance policies on one woman. He collected
on three of them successfully, but the fourth launched an
investigation and the whole grizzly story came out. Oh my god. Gerard,
his wife, and his mistress were all arrested, but Gerard
himself died of tuberculosis before confessing, and he maintained his
innocence until his last breath. Wow.

Speaker 4 (49:37):
Okay, dark dark huh again?

Speaker 1 (49:40):
One more last dark one that I'm going to mention
briefly because so many of you out there would not
forgive me for skipping this one, and I think at
least a handful of you have reached out and mentioned this,
And this is the twenty twenty three death cap poisonings
in Australia. This is a very quick version of this story,
except I'm sure there are true crime podcasts that have

(50:02):
covered it. In July twenty twenty three, a woman named
Aaron Patterson invited her ex in laws over for lunch.
So this is her ex husband's parents, Gail and Don,
and his mom's sister and her husband Heather and Ian,
and she fed them beef Wellington. The next day, all
four guests but not Aaron, went to the hospital with

(50:25):
gi distress, and over the following week, three of the four, Gail, Don,
and Heather died. Ian recovered, but only after weeks and
tests revealed death capt mushrooms as the cause of their death,
and a few months later, Aaron Patterson was charged with
three counts of murder and five counts of attempted murder,

(50:46):
which included times over the previous years when her ex
husband got really sick of suspected food poisonings. So he
was actually supposed to be at that lunch, but he
canceled last minute. Wow. As of the time of this recording,
the last update is that Aaron pled not guilty. I
think in May twenty twenty four, and the case is

(51:06):
going to the Supreme Court of Victoria. And there's lots
more out there on this case if you'd like to
read more. The food dehydrator that she threw away after
the lunch, her kids also eating the beef Wellington with
the mushrooms scraped acide. There's yeah, But we're not a
true crime podcast, so that's that's where I'm going to

(51:27):
leave things. Oh my gosh awful, though awful awful, And
these famous or infamous mushroom poisonings may make up most
of the headlines for death caps, but they represent only
a small proportion of all of the deaths or illnesses
caused by these mushrooms. For Agrippina to use this as
her murder weapon, she had to have known that their

(51:50):
consumption was deadly, which means, of course, that people had
eaten them and gotten sick or worse for centuries. As
Gerard's mushroom picker, theo was collect being the wrong kind
of mushroom, i e. The non toxic kind.

Speaker 4 (52:03):
The opposite or when you would normally call the wrong kind.

Speaker 1 (52:08):
Other people were making the opposite mistake and bringing home
death caps for their evening meal. In fact, the same
year that Girard was arrested, thirty one school children in
Poland died after eating a meal containing Amanita filoides that
had been served at school at school. Isn't that absolutely
devastating awful? So sad. Accidental ingestion of Amanita filoides has

(52:33):
always been a hazard for mushroom foragers in the areas
where this mushroom grows naturally, and it turns out that
area is growing the death cap. Mushroom's natural range is
in Europe, as you mentioned, but in the early decades
of the twentieth century, around the nineteen twenties or nineteen thirties,
it was introduced to California, not intentionally, but it likely

(52:55):
hitchhiked in soil or ornamental trees or shrubs brought over
from your which were then planted. The oldest Amanita filoides
specimens are from nineteen thirty eight and nineteen forty five
and come from Monterey County and Berkeley. Since their accidental introduction,
the mushrooms have actually seemed to really take to the
California habitat and have successfully established populations in natural environments,

(53:21):
gradually expanding their range with a corresponding increase in accidental
poisoning cases, and California isn't the only place we've seen
Amanda feilodes find its footing. As this deadly mushroom expands
its distribution, there has been a pressing need to get
better at treating people and animals who have ingested them,

(53:42):
and we've really made strides as far as that goes.
I mean, it's not perfect, but we really have made strides. Yeah, major, major.
In the early twentieth century, mortality rates from amatos and
poisonings were upwards of sixty to seventy percent. With the
introduction of fluid replacement therapy and better supportive care, that
dropped to thirty percent, and it's even lower today. It

(54:04):
is we'll talk about it. And while we don't have
a cure for amatoxin poisoning, we do have a rapid
diagnostic test shout out to Candice Beaver and team, which
can really help healthcare professionals identify the cause of poisonings
much more rapidly than before and start people on the
support of care that they need so much sooner. Deathcat
mushrooms are responsible for the majority ninety percent of mushroom

(54:28):
related deaths around the world. Their toxicity is extreme, like,
like we said, half a mushroom can kill a person.
It almost puts rice into shame. Why are these guys
so very, very deadly? What purpose, if any, do their
ToxS and serve? Right, is a fantastic question. The short

(54:51):
answer is that it's likely for defense against things that
eat fungi, insects, nematodes, gastropods like slugs, and possibly other
a animals. Okay, this is a common reason that fungi, plants,
and animals evolve the ability to produce similar toxins. The
long answer to this question of why is that we
don't fully know. Of course we don't know, of course

(55:12):
not We don't know precisely which organisms are the target
of this toxin. Is it mammals maybe, But the toxin
takes a long time to act, which could make it
more difficult to associate the mushroom with symptoms. So it's
like not a great learning tool, right, Yeah, that's.

Speaker 4 (55:31):
What's so confusing about it. And it's like the other
thing is like just how potent it is?

Speaker 1 (55:36):
Uh huh, right, And there doesn't seem to be any
evolved resistance to the toxin. In the mammal species that
have been studied, which is hot, very many species, but
still yeah, so in a lot of these papers, especially
the older ones, there will be repeated this like common
knowledge that squirrels are immune. But in this book that

(55:57):
I read about this, the author was like, I try
to track down the original study or source, and I
can't find anything. So yeah, So, I mean, it's possible
that mammal sensitivity could vary across species, but we don't
have good data, mostly just anecdotes, and it might just
be that mammals are collateral damage. Interesting, so is it insects?

(56:19):
This seems more likely. Insects are more numerous across a
landscape and thus maybe a stronger driver for this toxins production.
And plus, studies of different Drosophila species, so Drosophola, that is,
genus of flies, show that resistance to amatoxin varies across species.
Some Drosophila species which feed on fungi are more resistant

(56:40):
to the toxin than those that don't, and this resistance
might offer an advantage to these flies beyond just surviving
a meal. One study showed that these toxin producing mushrooms
might prevent these flies from getting parasitized by nematodes.

Speaker 4 (56:56):
What Yeah, because the toxin is there and there body,
and so then that kills the nematodes or.

Speaker 1 (57:02):
Something something like that. I think. Yeah. The study of
these toxins is fascinating, especially because they bear similarities to
other toxins produced across the animal kingdom, like venoms in
cone snails, snakes, and spiders, and they could be affecting
how this mushroom expands its geographic range and deals with

(57:25):
environmental change. And so with that, Aaron, you're that, I'm
leaving you with that, leaving you at that to tell
us where we are with this mushroom today. I have
so many different questions.

Speaker 4 (57:39):
So do I does that mean there's changes in like
RNA polymeras and those flies? Like what is the mechanism
of precisions?

Speaker 1 (57:46):
I have so many questions. I'll link to the paper.

Speaker 4 (57:49):
Okay, okay, I'll read more, but we'll we'll wrap up
soon right after this break. We've said it a few

(58:21):
times now, but it bears repeating that this mushroom is
now everywhere. It's on every continent except Antarctica. It is
absolutely spreading, especially in places like California through parts of Canada,
the Pacific Northwest, anywhere where suitable trees exist, and there's

(58:43):
a wide variety of tree species by the way that
this mushroom grows in association with so and like you
mentioned aaron deathcap. Mushrooms specifically Amanita filoides in all of
the papers, in all of the research are by far
way the most common cause of mushroom related death, responsible

(59:05):
for over ninety in some papers, ninety five percent of
deaths related to mushroom ingestion. How many deaths a year
does this mean? I still don't really know. A lot
of papers cite somewhere between fifty and one hundred deaths
annually across Europe, but in some years up to one

(59:27):
hundred deaths have been reported in China alone, So how many?
And in places like the US and Canada, it really
can vary year to year because some years there are
kind of big whether it's because of rainfall where there's
a lot more of this mushroom growing and then people
find it unintentionally, So it really can vary year to year.

(59:50):
And then the other big question that can also vary
is like how likely is it that a poisoning will
be deadly? And this depends on so many different factors,
not only how much mushroom did a person consume, were
they able to get access to healthcare, did that healthcare
facility quickly figure out that it was death cap toxicity?

(01:00:12):
Did they treat it correctly? What part of the mushroom
did they eat? How high was that particular mushroom in amatoxin? Like,
it really really can vary. Looking at like all the
case studies over the last several decades, it really can
vary what the case fatality rates tend to be. And
it's anywhere from five to thirty percent of cases that

(01:00:34):
end in death in recent years, And it varies country
to country. How micophobic or micophilic countries are I loose
their new words I learned, so I wanted to throw
those in here.

Speaker 1 (01:00:48):
I learned that too, and I was like, I, yeah,
it cracked me up because I had never really thought
that much about it. Me neither.

Speaker 4 (01:00:56):
But there are like countries like the US, for example,
microphobic countries we don't tend to forage a lot for mushrooms,
whereas some places in Europe are considered mycophilic countries where
foraging for mushrooms is like a big part of cultural
traditions in those areas. So in those areas you're going

(01:01:17):
to see more accidental exposure to mushrooms, but also in
combination with more knowledge about mushrooms overall. So it kind
of it all just depends, honestly year to year.

Speaker 1 (01:01:32):
Yeah. Well, and this is where I feel like awareness
and raising awareness is so important.

Speaker 4 (01:01:38):
It's so so so important because aarin. So there was
a kind of outbreak that happened in twenty sixteen in
northern California. There were fourteen total cases that were reported.
Nobody died, but three people ended up needing liver transplants,
including one eighteen month old baby who ended up with
really severe neurologic impairment because of how star she got

(01:02:00):
from liver failure.

Speaker 1 (01:02:01):
Oh my god.

Speaker 4 (01:02:02):
So, what was very notable to me in reading the
case reports about this outbreak is that people were ingesting
mushrooms that other people handed them without any idea in
some cases who those people were. It was like strangers
who were giving them mushrooms that they foraged, and without

(01:02:22):
any knowledge necessarily that that mushrooms could be this deadly
or that this deadly of a mushroom existed in this region.
So it really does come down to knowledge of what
mushrooms you're eating, how to know which ones are poisonous
and which ones are not, because they can sometimes look
really similar, especially depending on the stage of mushrooms like

(01:02:44):
early like young Aminita filoides can look really similar to
a lot of other edible mushrooms, whereas they look more
distinctive as they're matured. So it just it really can
depend and where you find them and in what association.
Like Yeah, So one other big need in addition to
awareness among people who are foraging and consuming mushrooms, is

(01:03:06):
also awareness among healthcare providers and the ability to confirm
that suspicion once you've thought of it, and especially a
type of detection method that is cheap, that is easy
to use, and that is fast because every moment.

Speaker 1 (01:03:22):
Counts, every moment counts.

Speaker 4 (01:03:25):
And like you mentioned, Aaron, people have been working on
exactly this. Shout out to Candice Beaver, thank you for
contacting us and providing so many sources. By the way,
super helpful. There now exists a test like this. It
works a lot like a COVID test or a pregnancy
test where you put urine or mushroom tissue that you
extract onto a little test that looks like a COVID

(01:03:47):
test and two lines means negative for amatoxin and one
line means positive for amatoxin. And this has been used
both now in theory and also in practice. So it's new,
but it exists, and it's cheap. It's like ten dollars
a test. And like, I don't forage for mushrooms, but
if I did, I would definitely buy some of these tests.

(01:04:08):
So yeah, so those kinds of diagnostic tools need to
be able to be in the hands of people not
only who forage, but also veterinarians and healthcare providers like
people who are going to be seeing amatoxin poisoning on
the front line. And then also newer treatment methods is
the other thing. And it goes without saying that this

(01:04:29):
is a huge area in need for research because we
don't have anything that specifically treats or targets amatox and poisoning.
There was a paper that came out in Nature in
twenty twenty two that got a lot of press because
it was very exciting and it was using a medicine.
It's not really medicine, it was using a substance called
indocyanine green, which is actually a die that is used

(01:04:54):
in medical diagnostics. So we use it not uncommonly in
diagnostics for looking at things like liver output or cardiac output.
And in this study that they published, it was effective
at stopping amatoxin from entering liver cells in mice and
in culture, so not in human peoples. But it's still

(01:05:15):
a really big deal because this is something like milk
thistle that is already available in the US because it's
already used in diagnostics. Right, So while we don't have
anything like immediate, like brand new treatment, we do have
people doing that research and things on the horizon which
is really important, and that arin is death cap mushrooms.

Speaker 1 (01:05:39):
I Before we do sources, I want to plug poison
control hotline poison control hotline and pet poison control or
animal poison control hotlines. Both of these things are crucial
and people are amazing and how they can help you.

Speaker 4 (01:05:55):
Like they're the ones who are going to think of
mushroom poisoning. Yes, I if I forgot to ask that question,
they're not going to forget to ask that question, right.

Speaker 1 (01:06:05):
And also, like mushroom I D is another really important
thing that experts can do. So it's just yeah, don't
forget poison control.

Speaker 4 (01:06:15):
Poison control one eight hundred two two two one two
two two. If you don't have it saved on your phone,
you can save it.

Speaker 1 (01:06:21):
You can save it. And there's an animal. I have
the animal one. It is eight eight four two six
four four three five. Does that work across the whole US?
I'm not sure it has worked for me in Colorado. Okay,
it's a call out for my little puppy. He was fine. Good.

Speaker 4 (01:06:40):
Not for mushrooms.

Speaker 1 (01:06:41):
Not for mushrooms. I forget what it was for. Oh,
cherry pits. Oh I remember that. Yeah, that was a
really lovely evening of cleaning up vomit. He was fine,
he was fine. Everything's fine.

Speaker 4 (01:06:53):
Well, if you want to read more, we have so
much more. I also have a great paper. It's not
my turn yet, but about or generally all the other
toxins that are present in mushrooms and all the other
syndromes that you can get from other mushroom toxicity. So
we really need to do more episodes on mushroom toxins.

Speaker 1 (01:07:11):
Love it. Let's I mean, I would I would love
to do that. Yeah, do you want to go first.
I mean, I guess that was the cool paper. Other sources,
there was two papers that I read by Vetter, one
from twenty twenty three and an older one from nineteen
ninety eight. So the twenty twenty three one was published
in Molecules and it was called Amantin's The most Poisonous
Molecules of the Fungal World.

Speaker 4 (01:07:32):
And a few other really interesting papers on amanita, on
Amanita filoides, on the amatoxins in general, some really depressing
ones like when people got it wrong in how they
treated an amanita poisoning before someone got to the hospital
and the consequences of that, and then also the MMWR

(01:07:53):
report about that outbreak in twenty sixteen in northern California. Aaron,
you should go, because then I usually do the wrap ups.
I don't know how to end my.

Speaker 1 (01:08:02):
Sources section. Hilarious. I don't know. I don't know how
to end this. So I have a number of articles
and maybe a book or two in there. The book
where I got a lot of sort of the history
part of that Amanita filoides is from Mushrooms, Poisons and
panaceas a handbook for naturalists, mycologists, and Physicians by Dennis Benjamin.

(01:08:27):
And if you want to read more about the evolutionary
significance of these toxins, there is a chapter in a
book and the chapter is titled Ecology and Evolution of
the Amanita cyclic peptide toxins and that is by Walton
from twenty eighteen. I also think I.

Speaker 4 (01:08:45):
Might have mis spoke and said that the paper that
was using indosigning green came out in twenty twenty two.
It was actually twenty twenty three in Nature Communications. But
we'll post all of the sources from this episode in
all of our episodes on our website, this podcast will
Kill You dot Com under the episodes tab.

Speaker 1 (01:09:01):
We will a big thank you again to the provider
of our first stand account. We really cannot thank you
enough for being willing to share your story and for
all the awareness work that you do. Yeah, thank you.

Speaker 4 (01:09:14):
Thank you also to Bloodmobile, who provides the music for
this episode and all of our episodes.

Speaker 1 (01:09:18):
Thank you to Tom Bryfogel and Leanna Sculacchi for the
amazing audio mixing.

Speaker 4 (01:09:22):
Thank you to everyone at Exactly Right Network.

Speaker 1 (01:09:25):
And thank you to you listeners. We hope that you
learned something about mushrooms. How do you feel about mushrooms?

Speaker 4 (01:09:31):
Do you eat mushrooms? Do you not eat mushrooms?

Speaker 1 (01:09:33):
Do you forage? Forage mushrooms? I'm really microphobic or microphilic.
I'm microphobic or somewhere in between. Micah neutral, oh, mico neutral.
I like that.

Speaker 4 (01:09:44):
And as always, a special thank you to our patrons.
Thank you so much for your support. It really means
the world to us.

Speaker 1 (01:09:52):
It does, it does well. Until next time, wash your
hands you feel the animals.

Speaker 3 (01:10:04):
Bumba bumba, bumba, bumba bumba