Extreme chilli risks

The short answer¶

For most healthy adults, eating a very hot chilli is painful but not dangerous. Capsaicin, the compound that makes chillies hot, activates the TRPV1 receptors that normally signal heat, so the body reacts as if it were being burned even though, at culinary doses, it is not. The pain, sweating, streaming eyes and hiccups pass, usually within an hour or so, although stomach cramps and an unpleasant next day are common.

The picture changes with the superhot varieties, such as the carolina-reaper and ghost-pepper, and even more with concentrated capsaicin extracts, which can be many times hotter again. A small number of well-documented cases show that very large doses can cause genuine harm, and that people with some underlying conditions are more at risk.

Documented cases¶

• Severe headaches. A case report published in BMJ Case Reports in 2018 described a man who developed repeated, excruciating "thunderclap" headaches after eating a Carolina Reaper in a chilli-eating contest in the United States. Scans showed a temporary narrowing of arteries in the brain, a condition called reversible cerebral vasoconstriction syndrome, which resolved.
• Oesophageal rupture. A 2016 report in The Journal of Emergency Medicine described a man who suffered a tear in his oesophagus after forceful vomiting following a ghost pepper eating challenge. He needed surgery and a long hospital stay.
• The One Chip Challenge. In 2023, a teenager in Massachusetts died after taking part in a social media challenge involving a single tortilla chip seasoned with Carolina Reaper and Naga Viper chillies. The medical examiner attributed his death to cardiac arrest after ingesting a high concentration of capsaicin, in a person with an underlying heart condition. The manufacturer withdrew the product from sale shortly afterwards.

Most of these were rare events, and each involved unusual circumstances, but they show why organisers of contests increasingly require waivers and have first aid on hand. See chilli-eating-contests.

Who should avoid superhots¶

The following are general precautions, not medical advice. People in these groups should think twice and, if in doubt, ask their GP:

• people with heart conditions or high blood pressure
• people with a history of reflux, ulcers or other stomach or oesophageal problems
• people with asthma or other breathing conditions, as fumes and coughing can trigger symptoms
• people prone to migraine
• pregnant people
• children, who should not take part in chilli challenges at all

Capsaicin extracts and "extract sauces" deserve particular care. They are far more concentrated than any fresh chilli and are intended to be used a drop at a time.

Skin, eyes and fumes¶

Capsaicin is also an irritant outside the mouth. Handling superhots without gloves can cause burning skin that lasts for hours, and rubbing your eyes afterwards is memorable. Cooking large quantities of hot chillies, especially dry-roasting or frying them, can release fumes that cause coughing and sneezing through the house. See handling-chillies-safely and making-chilli-oil.

When to get help¶

Call 999 if, after eating a very hot chilli or extract, someone has:

• chest pain or pressure, or a very fast or irregular heartbeat
• difficulty breathing, or swelling of the mouth or throat
• a sudden, severe headache
• severe pain in the chest or upper abdomen after vomiting, which can be a sign of an oesophageal tear
• collapse, confusion or fainting

Call NHS 111 for persistent vomiting, severe stomach pain, or if you are worried and it is not an emergency.

Keeping perspective¶

People in many parts of the world eat hot chilli every day without harm, and tolerance builds with habit (spice-tolerance). The problems above come from deliberate extremes: eating a whole superhot quickly on an empty stomach, or swallowing extract. Hot food as part of a meal, with rice, bread or dairy alongside, is a very different thing.

See also the-scoville-scale, hottest-chilli-records, capsaicin and chilli-pepper.