Ep. 209 - When Bad Fish Mimics a Heart Attack: What You Need to Know About Scombroid Poisoning
Tue Feb 03 2026
A healthy 65-year-old man eats raw tuna and within an hour ends up in the emergency room with dangerously low blood pressure, severe gastrointestinal symptoms, and EKG changes that look like a heart attack. What happened next surprised even his doctors.
Dr. Dean Mitchell walks through a real case published in the Journal of the American Medical Association that highlights a lesser known but serious foodborne illness called scombroid poisoning. Often mistaken for an allergic reaction or cardiac event, this condition is caused by high levels of histamine in improperly stored fish and can lead to shock, respiratory failure, and ICU level illness.
This episode breaks down how scombroid poisoning happens, which types of fish are most commonly involved, why it can be so hard to detect, and what subtle clues may warn you that something is wrong before symptoms spiral. Dr. Mitchell also explains why this reaction is not a true fish allergy and what to be cautious about when eating seafood at restaurants, buffets, cruises, or outdoor events.
A fascinating and important listen for anyone who eats fish and wants to stay informed and safe.
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A healthy 65-year-old man eats raw tuna and within an hour ends up in the emergency room with dangerously low blood pressure, severe gastrointestinal symptoms, and EKG changes that look like a heart attack. What happened next surprised even his doctors. Dr. Dean Mitchell walks through a real case published in the Journal of the American Medical Association that highlights a lesser known but serious foodborne illness called scombroid poisoning. Often mistaken for an allergic reaction or cardiac event, this condition is caused by high levels of histamine in improperly stored fish and can lead to shock, respiratory failure, and ICU level illness. This episode breaks down how scombroid poisoning happens, which types of fish are most commonly involved, why it can be so hard to detect, and what subtle clues may warn you that something is wrong before symptoms spiral. Dr. Mitchell also explains why this reaction is not a true fish allergy and what to be cautious about when eating seafood at restaurants, buffets, cruises, or outdoor events. A fascinating and important listen for anyone who eats fish and wants to stay informed and safe. Support the Show on Patreon - Join here! If you’d like to go deeper beyond the weekly episodes, you can become a member of The Smartest Doctor In The Room Patreon community. Patreon members receive access to bonus content, extended discussions, and thoughtful medical Q&As that expand on the topics covered on the show. It’s a space for listeners who want more context, nuance, and ongoing conversation around health and medicine. Your support helps keep the podcast independent and allows Dr. Mitchell to continue sharing honest, experience-based insight without outside influence. Contact Dr. Mitchell: Email: care@mitchellmedicalgroup.com Website Instagram YouTube Facebook LinkedIn Order your copy of Dr. Mitchell’s latest book, Conquering Candida, here. Be sure to visit ImmunoLytics & use coupon code SmartestDoc for 5% off