Introduction
POISONOUS MUSHROOMS
Not as Bad as You Fear

Fungi ben musheroms;
there be two manners of them,
one manner is deedly and
slayeth them that eateth them
and be called tode stoles,
and the other doeth not.

THE GRETE HERBALL, 1526

T he horror stories abound: tragic tales of poor souls who mistakenly ate the wrong mushroom and were found dead in their beds. People sometimes tell me anecdotal accounts of entire families that died following a meal of mushrooms the night before. Even knowing that such stories must be false, I still find them both frightening and compelling. The reality is that there are cases of several members of a family dying from poisonous mushrooms, though never within twenty-four hours. Deadly mushrooms have a delayed onset of symptoms and take days to kill the victims.

Still, deaths by poisonous mushrooms are rare, in spite of growing concern that mushroom poisoning is on the increase. The perceived risk far exceeds the reality. Though medical providers see several thousand people each year due to concerns regarding mushroom poisoning, almost none of those people die and very few require medical intervention beyond activated charcoal and anti-emetics, if medical intervention is needed at all. The national network of Poison Control Centers handles 8,000–10,000 mushroom-related calls each year, almost 80 percent related to toddlers or young children.¹ Of those mushroom calls made to Poison Control Centers, fewer than 5 percent develop moderate or worse symptoms requiring significant hospital emergency room intervention, and fewer than1 percent are considered severe, requiring inpatient hospital admission. For the thirty years ending in 2005, one or two people per year, on average, died of mushroom poisoning in America.² There was a surprising increase in 2009, when five people died of mushroom poisoning in the United States and Canada, according to preliminary reports compiled by the North American Mushroom Association (NAMA) Toxicology Committee chair Michael Beug. Four of the deaths were from amatoxins and the last, a man in his nineties, died from complications related to eating a type of bolete.³ Still, despite the increase in 2009, compared to the number of people injured and killed each year by lightning (about 100), bee or wasp stings (30–50), or peanuts (up to 100), mushrooms are quite safe.

But while it’s important to put the risk of mushroom poisoning into perspective, it’s also important never to dismiss that risk. Several times over recent years I have identified poisonous jack o’lantern mushrooms in cases where a very sick person was certain that they had collected and eaten chanterelles. The green-spored Lepiota, Chlorophyllum molybdites, causes moderate to severe gastrointestinal anguish to several dozen people each year and consistently leads the list across America for the most frequent cause of mushrooming malaise.⁴ If you never eat a wild mushroom, you’ll never be poisoned by one, but if you aspire to eat wild mushrooms, it is vital that you acquaint yourself with this darker side to mushroom foraging.

If the emerging mycophagist acts responsibly, acquires good basic mushroom identification skills, and learns the common edible and common toxic species in his or her area, there is little risk of a bad experience. This is especially true for someone collecting and eating only common, easily recognized mushrooms like chanterelles, morels, or puffballs and avoiding the temptation to practice extreme mushrooming where the goal is to develop the longest list of different mushrooms eaten.

This section is in no way a comprehensive treatment of the toxic mushrooms in any region of America. There are plenty of great books, articles, and Internet sites that can fill that need. Rather, the goal is to look at commonly encountered scenarios in mushroom poisoning and suggested strategies for avoiding those pitfalls, as well as to underscore the worst-case scenario by looking at the death cap, the deadliest mushroom in the world. I’ll also take a look at the ever increasing body of knowledge on the interaction of mushroom toxins in the human body. There are several mushrooms with significant histories as edibles, especially in Asia and Europe, that we now know are capable of triggering life-threatening illness and even death. When this happens with a mushroom that has an extensive history of collection and consumption, people’s resistance to accepting the change in status can be significant. We will take a close look at three mysterious cases of mushrooms that have long edible histories and examine the information that has come to light and tarnished their status.