“The mushroom toxicity literature is littered with poor or questionable information. Rarely is it challenged. Once a mushroom is declared toxic it is difficult to change its designation.” individuals ate the same mushrooms and in what quantity, and did all who ate the mushrooms develop symptoms? What were the heavy metal concentrations in the mushrooms? Could the mushrooms have been contaminated with pesticides, solvents etc? Did these patients have any genetic predisposition to muscle disease? How was this possibility investigated? Is this isolated to one region of the country and not reported from elsewhere? Is there a geographic / environmental / habitat/mycorrhizal / Denis R Benjamin to the medical literature as well as an seasonal difference in the putative toxin (The Cowtown Curmudgeon) editor, the fallibility of the scientific production? Is the T. equestre in France The Botanical Research Institute of Texas medical enterprise was always close to the same species as T. flavovirens in the Fort Worth, Texas the surface. Peer review, the system used USA as is claimed? In short, the report to validate a scientific study is a very raised far more questions than answers. aving recently completed a imperfect mechanism. The initial experimental data was also mycophagy survey with almost Being published in a “prestigious” fraught with problems. The quantity 500 respondents from around medical journal provoked much administered to a few mice equated to Hthe USA, I was struck by the number commentary in the lay press with a total of 6.6 pounds of mushrooms of people who occasionally eat “Man- dramatic headlines like “The Muscle ingested over three days by a 150-pound on-Horseback” despite fifteen years of Destroying Mushroom.” The French human—a prodigious and unrealistic warnings from many of the amateur investigators described twelve quantity. Administration of the mycological societies and clubs to avoid individuals who suffered muscle mushroom powder itself produced a this mushroom. No adverse effects from damage (rhabdomyolysis) after eating bare twofold rise in the muscle CPK eating this mushroom were reported large quantities of T. equestre over a enzyme, a less than convincing increase. by any of the participants in our three-day period. Supposedly they Moreover, to claim a dose dependent survey. Even that font of all knowledge, excluded the many other causes that can effect when only three groups of three Wikipedia, has declared this mushroom produce identical symptoms, including mice was tested stretches statistics to toxic. This followed a publication about exercise, drugs, infections, cold, alcohol, its outer limits. The remainder of the the possible toxicity of Tricholoma endocrine disorders, etc. initial experimental data was equally equestre in the New England Journal of The report was intriguing, but raised problematic, since highly concentrated Medicine (Bedry et al., 2001). numerous questions not addressed in extracts were employed. Later experi- The discordance between how the manuscript such as: incomplete ments have not clarified the picture. people were behaving and “official” clinical histories including, exertion, This report was followed by a few recommendations began my reflecting dietary and drug details of each similar cases from Poland (Chodorowski on a number of issues, including science, patient. They should have included the et al., 2002; Chodorowski et al., 2003; publication and peer review, liability, and quantity of mushroom material actually Chodorowski et al., 2004; Chodorowski critical thinking. eaten, the mode of preparation, who et al., 2005; Chwaluk, 2013; Sein Anand “Ladies and gentleman, you are identified the mushrooms, and any and Chwaluk, 2010). Every couple of embarking on a career in medicine. Our alcohol ingestion. The fate of “control” years there are claims that the putative role is to teach you what we know. At subjects was never reported, since it toxins have been identified (Nieminen least 50% will prove to be wrong. Your is most unlikely that others did not et al., 2008). There have been no further problem is that you don’t know which eat a similar quantity of mushrooms. reported occurrences from France, 50% that is.” So began my education Eating alone is not common practice in although it is likely that people still in the healthy skepticism that has France, and presumably friends or family eat this mushroom. To confuse the informed my career. As a contributor shared these meals. How many other issue even further, a recent publication FUNGI Volume 9:4 Winter 2016 9 about Tricholoma terreum, which has publication feels obligated to adopt interaction between statins or fibrates never been shown to cause any issues the prudent approach of declaring this and consumed Tricholoma equestre. in humans, was claimed to have some mushroom at least of questionable Przegląd lekarski 62(6): 468-470. unusual toxin in an experimental model edibility, if not frankly toxic. France Chwaluk, P. 2013. Rhabdomyolysis as producing rhabdomyolysis and also and Poland no longer permit the an unspecyfic symptom of mushroom affecting cardiac muscle (Xia et al., commercial sale of Tricholoma equestre poisoning—a case report. Przegląd 2015). Other than the genus name, there (Peintner et al., 2013). However the lekarski 70(8): 684-686. was no reason to relate this to Man- ambivalence towards this fungus Giannopoulos, D., S. Voulioti, A. on-Horseback, and yet that is exactly persists, as evidenced by this statement Skarpelos, A. Arvanitis, and C. what the authors and science journalists from a Spanish mycological society: Chalkiopoulou. 2006. Quail poisoning managed to do. Guilt by association—a “the existing controversy regarding its in a child. Rural Remote Health wild speculation. potential toxicity, it is our duty not to 6(2): 564. Why has there not been a single recommend its consumption or at least Korkmaz, I., F.M. Kukul Güven, S.H. report of muscle damage from eating consume with caution, although we Eren, and Z. Dogan. 2011. Quail this mushroom (T. equestre) in the USA? continue eating it without a hitch.” consumption can be harmful. Journal There are many possible reasons: So what is the bottom line? Only time of Emerging Medicine 41(5): 499-502. 1. What is called T. flavovirens is not will tell if this observation belongs in doi: 10.1016/j.jemermed.2008.03.045 the same species as T. equestre in the true column, or becomes relegated Nieminen, P., M. Kirsi, and A.M. Europe. to a rare, not well understood, event. Mustonen. 2006. Suspected 2. American mycophagists do not The book is not closed on this, so keep myotoxicity of edible wild mushrooms. find or eat the same quantity as watching and listening. There is still Experimental Biology and Medicine Europeans. much to learn. In the meantime, if you 231(2): 221-228. 3. The toxins are not produced do feel obligated to eat this mushroom, Nieminen, P., V. Kärjä, and A.M. in any of our ecosystems and avoid gluttony if faced with an unlikely Mustonen. 2008. Indications of habitats. surfeit of Tricholoma flavovirens and hepatic and cardiac toxicity caused 4. The original report was specious, don’t eat them at every meal. Live by the by subchronic Tricholoma flavovirens with the symptoms due to other words of Marcus Cicero: “never go to consumption. Food Chemistry and factors, e.g. the presence of a excess, but let moderation be your guide.” Toxicology 46(2): 781-786. statin medication (Chodorowski Papadimitriou, A., G.M. Hadjigeorgiou, References Cited et al., 2005) P. Tsairis, E. Papadimitriou, C. 5. Personal, unique factors such Aparicio, R., J.M. Oñate, A. Arizcun, T. Ouzounelli, and T. Ouzounellis. 1996. as genetics / metabolism / Alvarez, A. Alba, J.I. Cuende, and M. Myoglobinuria due to quail poisoning. immune system etc. are critical Miró. 1999. Epidemic rhabdomyolysis European Neurology 36(3): 142-145. predisposing requirements. due to the eating of quail: A clinical, Peintner, U., S. Schwarz, A. Mešić, P.-A. 6. Physicians have failed epidemiological and experimental Moreau, G. Moreno, and P. Saviuc. to recognize the association. study. Medicina Clinica 112(4): 143- 2013. Mycophilic or mycophobic? 7. Physicians have not taken the 146. [In Spanish.] Legislation and guidelines on wild necessary effort to document and Bedry, R., I. Baudrimont, G. Deffieux, et mushroom commerce reveal different publish any occurrence. al. 2001. Wild-mushroom intoxication consumption behaviour in European This muscle damage story is as a cause of rhabdomyolysis. New countries. PLoS One 8(5): e63926. somewhat analogous to another rare England Journal of Medicine 345: doi: 10.1371/journal.pone.0063926 problem reported from the eastern 798-802. Sein Anand, J., and P. Chwaluk. 2010. Mediterranean region known as Chodorowski, Z., W. Waldman, and J. Acute intoxication with Tricholoma corturnism. Every few years some who Sein Anand. 2002. Acute poisoning equestre—clinical course. Przegląd eat quail (Coturnix coturnix) develop with Tricholoma equestre. Przegląd lekarski 67(8): 617-618. severe rhabdomyolysis. Nobody knows lekarski 59(4-5): 386-387. Tsironi, M., P. Andriopoulos, why (Aparicio et al., 1999; Giannopoulus Chodorowski, Z., J. Sein Anand, and E. Xamodraka, S. Deftereos, A. et al., 2003; Korkmaz et al., 2008; M. Grass. 2003. Acute poisoning with Vassilopoulos, G. Asimakopoulos, and Papadimitiriou et al., 1996; Tsironi et Tricholoma equestre of five-year old A. Aessopos. 2004. The patient with al., 2004). Investigations have failed to child. Przegląd lekarski 60(4): 309-310. rhabdomyolysis: have you considered determine a mechanism. Could Man-on- Chodorowski, Z., M. Wiśniewski, J. Sein quail poisoning? Canadian Medical Horseback be the mushroom equivalent? Anand, W. Waldman, and A. Ronikier. Association Journal 171(4): 325-326. The mushroom toxicity literature 2004. Tricholoma equestre—animal Yin, X., T., Feng, J.-H. Shang, Y.-L. Zhao, is littered with poor or questionable toxicity study. Przegląd lekarski 61(4): F. Wang, Z.-H. Li, Z.-J. Dong, X.-D.