While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Benthic microorganism, C-CTX-1, C-CTX-2, chronic ciguatera fish poisoning (CCFP), ciguatera-related toxin maitotoxin (MTX), ciguatoxic barracuda (Sphyraena barracuda), ciguatoxin, ciguatoxin CTX3C, ciguatoxin-1, CTX3C, dinoflagellates, Gambierdiscus toxicus, ichthyosarcotoxic disease, ichthyosarcotoxism, marine dinoflagellates, P-CTX-1.


  • Ciguatera fish poisoning (or ciguatera) is caused by eating fish that contain toxins produced by the marine dinoflagellate microalga Gambierdiscus toxicus.

  • Ciguatera causes gastrointestinal, neurological, and cardiovascular symptoms. Signs and symptoms vary widely, but ciguatera usually presents as gastrointestinal symptoms, such as nausea, vomiting, diarrhea, and abdominal pain, accompanied by neurologic complaints, shortly after the ingestion of fish containing the toxins. Symptoms of ciguatera poisoning may persist for months or years.

  • Epidemics are most common along tropical and subtropical coasts and usually involve the ingestion of large carnivorous fish. Ciguatera toxins account for over half of fish-related poisonings in the United States. The toxins are odorless and tasteless. Fish known to have carried ciguatera toxins include barracuda, black grouper, blackfin snapper, cubera snapper, dog snapper, greater amberjack, hogfish, horse-eye jack, king mackerel, and yellowfin grouper.

  • Estimates place the annual number of ciguatera cases at 20,000 worldwide.


  • Not applicable.

Scientific Evidence


These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

No available studies qualify for inclusion in the evidence table.

*Key to grades:


The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Ciguatera is caused by a toxin and is not for therapeutic use.


The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Side Effects and Warnings

  • Avoid ingesting ciguatera toxin-containing fish in any amount. Caution is advised with ingesting certain tropical fish, which may contain the toxins. Ciguatera toxins accumulate in fish and, when consumed by humans, may cause moderate-to-severe gastrointestinal effects, as well as neurological and cardiovascular symptoms. Ciguatera is rarely lethal.

  • Ciguatera fish poisoning may cause low blood pressure. Caution is advised in patients taking drugs, herbs, or supplements that lower blood pressure.

  • Toxic effects of ciguatera poisoning include gastroenteritis (inflammation of the digestive tract). Ciguatera poisoning should be considered in the diagnosis of acute gastroenteritis.

  • Transfer of ciguatera toxins through ejaculation during sexual intercourse has been reported.

  • Ciguatera poisoning may cause abdominal cramps; acute respiratory distress; agitation (irritation); anxiety; bronchospasm; burning mouth syndrome; chills; chronic fatigue syndrome; coma; dental pain; diarrhea; difficulty speaking or swallowing; dry mouth; eye pain; flushing; hallucinations; heightened pain sensing and tiredness; hives; hypersalivation (excessive saliva production); impairment of any of the senses; itching of the skin and vulva; joint pain; malaise, metallic taste; movement disorder; muscle cramps, inflammation, pain, spasm, twitching, and weakness; nervousness; numbness; pain from normally innocuous cold stimuli; painful ejaculation; psychiatric disorders; rapid or slow heartbeat; reduced reflexes; reversal of cold and hot temperature sensing; seizures; septic shock and death; shortness of breath; skin conditions; sweating; tingling; tremors; unsteadiness; vertigo; visual disturbances, including blurred vision; and vomiting.

  • Ciguatera is caused by toxins, and reports of toxicity are more common than reports of allergy. Toxicity manifests as cardiovascular, neurological, and gastrointestinal symptoms, which are typically distinct from allergic reactions to fish.

Pregnancy and Breastfeeding

  • Avoid ingesting ciguatera toxin-contaminated fish during pregnancy and breastfeeding. Adverse effects in newborns have been reported in some, but not most, cases. Possible adverse effects on breast milk have been reported.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (


Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to Selected references are listed below.

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.