If you are active on Social media or are scrolling through the news online, you might be well aware of the current health crisis in Muzaffarpur city of Bihar. According to reports, more than 100 children died and around 300 are critical due to acute encephalitis syndrome(AES). The outbreak of encephalitis, which is a condition that causes inflammation of the brain, takes place every year but the death toll this year is alarming. While there can be numerous causes of encephalitis, it is believed that eating litchi is the key reason for the incidence of encephalitis in this region. And this has caused a stir all over the country with parents being concerned if eating litchi cause encephalitis.
Here is what research has to say about the role of litchi in encephalitis. But before that let’s know a bit about the disease acute encephalitis syndrome.
What is Acute Encephalitis Syndrome (AES)?
Encephalitis, known as chamki fever in Hindi, is a disease that causes inflammation of the brain. AES is characterized by an acute onset of fever and neurological symptoms such as mental confusion, disorientation, or coma as it affects the central nervous system. It mostly affects children below 15 years of age[1].
The main cause of AES in India is known to be viruses however, even bacteria, parasites, fungi, chemicals and toxins can also cause the disease. It is reported that people may suffer from the disease due to dengue, mumps, measles, scrub typhus, Nipah and Zika virus. According to a 2016 study[1], in addition to viral encephalitis, a severe form of leptospirosis and toxoplasmosis can also cause AES. The causative agent might vary with season and geographical status. Surprisingly, in some cases, the causative agent may also remain unidentified.
Litchi And Encephalitis: What’s The Link?
In Muzaffarpur, many kids have succumbed to AES and it is believed that eating litchi was the cause of it. This is because, it is being confirmed that encephalitis is spreading in litchi growing areas of Bihar, and the consumption of the fruit was among the key risk factors for the spread of the disease. This has also caused fear amongst many patients and even parents because litchi is a popular fruit and widely eaten all over the nation.
There are numerous health benefits of litchi. It is known to be a good source of vitamins and minerals such as Vitamin C, Vitamin B2, copper, and potassium. It also exerts antioxidant properties, anti-microbial and anti-viral properties along with anti-inflammatory properties. This fruit is not only good for diabetic but also recommended for obese and overweight individuals. It contains compounds which protect the liver and also boost immunity. Being rich in polyphenols (plant-based antioxidants), including proanthocyanidins, this fruit can help prevent serious heart problems and cancer.
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Dr. Pradeep Gadge, Diabetologist, Mumbai says, “It is essential to note that the cause of encephalitis includes sleeping on an empty stomach at night, dehydration due to humidity and eating litchi on an empty stomach. Not many people are aware of the fact that your blood glucose levels tend to dip early in the morning. This is a normal tendency and it happens because of no food intake for several hours. So if a kid, who is undernourished and has not eaten a meal at night, there is a high chance of developing hypoglycemia. It is a condition in which the blood glucose level drops too low (below the normal range of 4mmol/L). So sleeping on an empty stomach can further affect your blood glucose levels.”
For the body and brain to function, it needs normal levels of glucose in the bloodstream. Generally, glucose is stored in the liver as glycogen. So when the body requires glucose or when the glucose level in the blood goes down, this stored form of glucose is converted into active glucose and circulated in the blood for use. But in the case of undernourished children, there is a lack of adequate glycogen reserves in the liver which can be converted into the active form. As a result, this mechanism of glucose synthesis in malnourished kids in unable to meet the need, which causes hypoglycemia.
As the liver is unable to supply the need, to meet the demand, an alternate pathway of glucose synthesis, which is known as fatty acid oxidation, is triggered. Generally, fatty acid oxidation is turned on when the glycogen reserves in the liver are exhausted or insufficient. But, due to the presence of toxins known as hypoglycin A and Methyl Carboxy Phenyl Glycine (MCPG) in litchi, the conversion of fatty acid into glucose is blocked. As a result, no glucose is produced which further causes low blood glucose level.
A study published in the Journal Lancet Global Health[2] revealed that the recurring outbreak of acute encephalopathy is associated with both hypoglycin A and MCPG toxicity from litchi consumption. Moreover, it also concluded that the disease is also associated with the absence of an evening meal. To prevent illness and save lives, it is recommended to minimize litchi consumption among young children, ensure children receive an evening meal throughout the outbreak season and implement rapid glucose correction for children with suspected illness, suggested the study[2].
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Bottom line: Litchi fruit has numerous health benefits and it is widely eaten all over the world without any health complications. Given that the studies have revealed the consumption of litchi can cause encephalitis, the takeaway is to prevent kids from eating the fruit on an empty stomach. Also, avoid unripe litchi as it has a high level of MCPG, which further increases the chances of lowering blood glucose level. Eat ripe litchis in moderation along with a balanced diet to be on the safer side.
(The article is reviewed by Dr. Swati Mishra, Medical Editor)
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References:
Ghosh S, Basu A. Acute Encephalitis Syndrome in India: The Changing Scenario. Ann Neurosci. 2016 Sep;23(3):131-133. Epub 2016 Sep 9.
Shrivastava A, Kumar A, Thomas JD, et al. Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study. Lancet Glob Health. 2017 Apr;5(4):e458-e466.
Narain JP, Dhariwal AC, MacIntyre CR. Acute encephalitis in India: An unfolding tragedy. Indian J Med Res. 2017 May;145(5):584-587.