Most of you must have heard about the ongoing controversy around litchis this year. If not here is the story- hundreds of children in Muzaffarpur (Bihar) suffered from an acute neurological condition which led to the death of more than 110 children. More than 400 hundred children were admitted to the hospitals owing to this disorder which has been termed as Acute Encephalitis Syndrome (AES). 

So, how did litchi came in the picture? Well, litchis are being held as the main culprit behind AES.

Now, I am not a fan of litchi but I have had my fair share of this fruit every season since childhood and not once did I end up on a hospital bed. But since this controversy started many people have stopped buying litchis altogether. As a result, the sales have declined sharply and this has heavily affected the fruit sellers and traders. There are huge stocks of litchis lying with no one to buy them. But are litchis really responsible for this mess?

What Is Acute Encephalitis Syndrome?

AES or Acute Encephalitis Syndrome is a blanket term for a number of neural conditions such as Meningitis which is caused by virus or bacteria, Japanese encephalitis caused by a virus, Encephalopathy, Cerebral malaria, and Scrub typhus caused by bacteria, all together are called acute encephalitis syndrome.

Encephalitis in simple terms is the inflammation of the brain, caused by viruses, bacteria, fungus, parasites, spirochetes, chemicals, and toxins. However, the encephalitis we are talking about or the one that is caused by litchis is not caused by any microbes and is called encephalopathy.

Encephalopathy is biochemical in origin and is different from the rest of the encephalitis. In this particular case, encephalopathy is caused by hypoglycaemia and hence is called hypoglycaemic encephalopathy.

AES starts with the early symptoms of fever. Most of the children admitted were taken to the hospital due to acute fever. Early symptoms may also include mental confusion, disorientation. Symptoms can worsen within hours and can include serious complications like seizures, paralysis, and coma.

Also Read: How To Take Care Of Your Child’s Mental Health

Why Are Litchis Being Blamed?

In 2012-2013, a two-member team headed by virologist Dr. T. Jacob John suspected, and confirmed the next year, a toxin found in litchi was responsible for causing hypoglycaemic encephalopathy. According to another study about a 2014 outbreak of encephalopathy, published in The Lancet Global Health medical journal in 2017, one of the factors can be the consumption of lychee.

Litchis contain a toxin called Methyl Cyclopropyl Glycine (MCPG) which can trigger an acute overnight dip in sugar levels called hypoglycaemia. Most of the children who suffered from encephalitis were malnourished and went to bed on an empty stomach. It is normal for the blood sugar to drop in the morning as they had not eaten for so many hours. What generally happens is our body uses the glycogen stored in the liver when blood sugar is low. When glycogen reserve in the liver is exhausted or is not sufficient, the body converts the fatty acid (non-carbohydrate energy source) into glucose. But MCPG blocks a key enzyme involved in gluconeogenesis and the conversion of fatty acid into glucose is stopped midway. As a result, no glucose is generated and the blood glucose level is not brought back to the normal.

So, undernourished children who go to sleep without a meal at night develop hypoglycaemia. The brain needs normal levels of glucose in the blood but the liver is unable to supply the need. 

Also Read: Are You Suffering From Eating Disorder?

Why Well Nourished Children Are Not At Risk?

In well-nourished children, sufficient reserve glucose is stored as glycogen in the liver. Whenever the glucose level goes down, glycogen is broken down into glucose and circulated in the blood for use. However, undernourished children lack enough glycogen reserve and hence their body is unable to correct the glucose level in the blood, leading to hypoglycaemia.

Malnourishment and Litchis Together Can Be Deadly 

The toxin MCPG can even cause death in malnourished children. Because of the toxin, the body’s natural mechanism to correct low blood glucose level is blocked thus leading to a drop in fuel supply to the brain. This causes drowsiness, disorientation and even unconsciousness. Once the fatty acid conversion into glucose is stopped by the toxin, amino acids are released which are toxic to brain cells. The amino acids cause brain cells to swell and the children suffer from convulsions, deepening coma, and even death.

Also Read: 5 Daily Foods And Their Healthier Replacements

Litchis Worsen The Condition But Are Not The Only Cause

Blaming the entire scenario on litchis is not the way out. Many studies have been done on this topic and even though experts agree to the role of this fruit in worsening the situation, it is probably not the only reason that led to the deaths of hundreds of children.

What is common among all the children that were admitted to the hospital is that all of them were malnourished and most of them went to bed without having a meal. Also, most of them belonged to families who camped in litchi orchards during the harvest season. The high availability of litchi and scarcity of money made these children consume litchis in large quantities as a replacement for their meals. They roam around in the sun, eat litchis on an empty stomach, don’t take a meal before going to bed, and are malnourished. All these factors together led to this epidemic and not just litchis alone.

Another notable aspect is that this epidemic has affected only children and not adults. Children have considerably lower levels of body fat than adults, their body depends on reserves of glycogen released by the liver, the organ in which fat is also broken down in our body. 

Litchis are transported from Muzaffarpur to many big cities including Mumbai and Delhi. However, no such case has been reported in these cities. Had litchi been the only cause it would have also affected other areas where it is grown on vast areas as compared to Muzaffarpur.

Also Read: Hunger Pangs And Cravings: Dealing Scientifically

Can Hypoglycaemic Encephalopathy Be Treated?

Before even thinking about treatment, you can easily prevent AES by eating litchis in limited quantity, taking proper meals, and not going to bed without eating. In undernourished children too eating before going to bed and not eating too much of litchis on an empty stomach is sufficient to prevent this condition.

As far as treatment is concerned, hypoglycaemic encephalopathy can be easily treated. Complete recovery can be achieved if children with hypoglycaemic encephalopathy are infused with 10% dextrose within four hours after the onset of symptoms. Infusing 10% dextrose restores blood sugar to a safe level and stops the production of amino acid that is toxic to brain cells. 

Infusing 3% saline solution helps in reducing swelling of the brain cells. 

But if dextrose infusion is not started within four hours after the onset of symptoms, the brain cells may not recover and will ultimately die. As a result, even if the child survives, he/she will suffer from various aspects of brain damage. (1)

Why We Should Stop Blaming Litchis?

Urine samples of the children admitted in the hospital show that two-thirds of the children were exposed to toxins in lychee seeds, found in higher levels in unripe fruits. MCPG the main toxin being held responsible is found in the seeds and not in the pulp. 

Litchi is a nutritious fruit as it contains vitamin B, calcium, iron, potassium, phosphorus, and other minerals. 

The 2017 Lancet study clearly says that "The synergistic combination of (lychee) consumption, a missed evening meal, and other potential factors such as poor nutritional status, eating a greater number of litchis, and as yet unidentified genetic differences might be needed to produce this illness." 

Heat, malnourishment, and humidity could also be the contributing factors, according to experts.

Also Read: Fruit Juices- Not As Healthy As You Thought

Bottomline

All the research and insights by experts point to one thing- that litchis are not the only one to be blamed. If you take care of just a few simple things and provide adequate nourishment to your child, you have nothing to worry about.

So, stop contemplating whether to buy litchis or not from now on and enjoy your favorite fruit this season and every season to come.

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