Urology pearls – classic

Carolina Reaper is nothing to mess with

Shahar Madjar, MD, Journal columnist

EDITOR’S NOTE: This column originally appeared in The Mining Journal on April 24, 2018.

There are bad decisions and there are worse decisions that end up giving you a really bad headache.

George decided to participate in a hot pepper contest. “What can go wrong?” he must have asked himself. He ate the Carolina Reaper, the hottest pepper on the Scoville scale. His story was recently published in the medical journal BMJ Case Reports.

Scoville scale is a measurement of the pungency (spicy heat) of chili peppers and other spicy foods. It is reported in Scoville heat units. On this scale, bell peppers get a zero, poblano peppers are about a thousand, jalapeno and chipotle are anywhere between 2,500 and 8,500, cayenne peppers are between 30,000 and 50,000. The Carolina Reaper will rip you apart, at 1,400,000 to 2,200,000 SHU.

Several hours after George ate the Reaper, he developed dry heaves. Then came headaches: the pain started at his neck and at the back of his head, but soon after, it took hold of his entire head. During the next several days, he had several episodes, each lasting several seconds, of excruciating thunderclap headaches.

The doctors in the emergency department ordered a CAT-scan angiography of George’s head. The images showed no brain tumor, or hemorrhage, nor a brain aneurysm; instead, several of the blood vessels inside George’s brain seemed unusually constricted (narrow).

The doctors treated George with pain medications and waited for the Reaper to loosen its grip. Over the next several days, George’s headaches resolved. And a repeat CT angiography showed that the arteries in his brain had returned to their normal size.

This blood vessel constriction in George’s brain was a side effect of capsaicin which is the active ingredient in chili peppers. Capsaicin is an irritant in humans, producing a sensation of heat in any tissue it comes in contact with, including the skin and the tongue. In proper doses, this sensation is pleasant, interesting, and satisfactory, such as in: “I just had salsa at the Mexican, it was spicy, so delicious, I can’t even tell you.” In outrageous doses, though, it would give you a headache, or worse.

In an unrelated case report, published in the International Journal of Emergency Medicine, the authors describe the unfortunate case of a 25 year old Turkish man (call him Yusuf) who developed severe chest pain after ingesting cayenne pepper pills he took for dieting. These pills are not approved by the FDA, but are sold in the Far East, Russia and China. Yusuf was in excellent health, although he must have felt that losing a few pounds could only do him good. Several days after he had taken the ‘La Jiao Shou Shen’ cayenne peppers pills, he felt severe chest pain that radiated to his left arm, neck, and jaw. An ECG confirmed that he had a heart attack. He was treated with nitroglycerin, morphine, and heparin. His pain subsided. An emergency angiogram of his heart vessels showed that there was no permanent narrowing of his vessels, leading his doctors to conclude that the capsaicin pills must have caused Yusuf’s coronary vessels to only temporarily constrict, bringing about a heart attack.

Should you forgo your chili peppers? Not so fast. In Jun Lv’s article published in the British Medical Journal, researchers from the China, U.S. and the UK examined the association between consumption of spicy food and mortality. They examined 199,293 men and 288,082 women living in 10 geographically diverse areas across China.

The researchers reported that participants who consumed more spicy foods had lower rates of mortality. For example, compared with participants who ate spicy food less than once a week, those who consumed spicy foods 6-7 days a week had 14% relative risk reduction in their total mortality. Spicy food consumption reduced the risk of mortality from ischemic heart disease, respiratory disease, even cancer.

The association between consumption of spicy food and decreased mortality remained strong even after considering other risk factors such as age, smoking status, level of physical activity, and body mass index. Both men and women benefitted equally from eating spicy foods.

Should you increase the consumption of spicy food based on the Chinese study? Not so fast. First, the benefits of consuming spicy food may be correlated with other dietary habits and lifestyle behaviors common in people who consume spicy food. Cooking with chili peppers in the Chinese cuisine calls for more oil, and consumption of spicy foods is typically associated with increased intake of carbohydrates — rice, for example.

Is the benefit of spicy food a result of more spice, or is it the consumption of additional oil, or carbohydrates? Besides, a causal association between spicy food and decreased mortality may be reversed: perhaps people with chronic disease — those who are more likely to die — tend to avoid spicy food. The Chinese study could not address these questions.

So what to do? In my next article, I will share with you a recipe for a tangy, spicy dish that originated in North Africa. It doesn’t call for a Carolina Reaper pepper. There will be no headaches, nor heart attack. And even if it wouldn’t extend your life, it will give you yet another reason to live — this pleasant irritation on your tongue that comes with the right amount of spice.

EDITOR’S NOTE: Dr. Shahar Madjar is a urologist working in several locations in the Upper Peninsula. Contact him at smadjar@yahoo.com or at DrMadjar.com.


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