Can you die from eating extremely spicy food? Why do we have a love-hate relationship with chilli?

We don’t think much about it when we tuck into all manners of spicy food here, including Samyang’s popular range of Buldak instant noodles. The well-loved South Korean instant noodle brand recently gained infamy for being banned in Denmark for being too hot – in particular, the Buldak 3x Spicy & Hot Chicken, Buldak 2x Spicy & Hot Chicken, and Buldak Hot Chicken Stew.

The Danish Veterinary And Food Administration even said in a statement on Jun 11 that the spice level in a single packet of the noodles was "so high that they pose a risk of the consumer developing acute poisoning”. "If you have the products”, the statement added, “you should discard them or return them to the store where they were purchased”.

Just how spicy are these instant noodles? Definitely not as fiery as biting into a cili padi or bird’s eye chilli, which measures 100,000 to 250,000 SHU (or Scoville Heat Unit) on the Scoville scale. And certainly nowhere near the 2.6 million SHU reserved for the pepper so hot, they named it Pepper X.

The hottest of the banned trio in Denmark, Buldak 3x Spicy & Hot Chicken, stands at 13,200 SHU, followed by the Buldak 2x Spicy & Hot Chicken at 10,000 SHU. The Buldak Hot Chicken Stew, at 4,400 SHU is slightly higher than the jalapeno pepper’s 4,000 SHU.

Then again, spiciness is relative and one man’s MacDonald’s garlic chilli sauce could be another’s mala xiang guo. But can the heat cause acute poisoning like the Danish food agency said? And could you potentially die from eating face-meltingly spicy food? We find out from the experts.

CAN EATING OVERLY SPICY FOOD KILL YOU?

That notion probably rose from reports on an American teenager, who died in September 2023 from eating a single tortilla chip dusted with Carolina Reaper and Naga Viper pepper extracts. It was known as the One Chip Challenge on social media and Amplify Snack Brands, the company behind the Paqui chip brand, promptly pulled the product from the shelves.

Could death by spicy food be a thing? First, the chillies in question are two of the hottest varieties ever recorded, other than Pepper X. The Carolina Reaper has a fiery score of 2.2 million SHU, while the Naga Viper stands at 1.3 million SHU. Furthermore, the 14-year-old’s death was caused by cardiopulmonary arrest, which could have been contributed by an enlarged heart, which is a congenital heart defect, according to AP News.

“There have been reports of acute toxicity with capsaicin causing ischaemia of the heart muscle,” said Dr Syed Haider, a cardiologist at MedStar Washington Hospital Center in the news report. “Large doses of capsaicin can increase how the heart squeezes, putting extra pressure on the artery.”

But such incidents are rare. "You might feel like you’re dying but eating profoundly spicy food is highly unlikely to cause death”, said Dr Shim Hang Hock, a gastroenterologist from Parkway East Hospital. “Most people may experience symptoms such as intense pain, burning sensation, diaphoresis, nausea and vomiting. But these sensations are temporary and will not lead to death.”

Still, it pays to know your tolerance limit as “extremely high levels of spiciness could worsen existing medical conditions” in rare cases, said Dr Shim.

WHY DO WE HAVE A LOVE-HATE RELATIONSHIP WITH SPICY FOOD?

“Capsaicin is the active chemical compound in spicy food that contributes to the pungent flavour,” said Dr Shim. “Capsaicin binds to the TRPV1 (or transient receptor potential V1) receptor, which detects heat and pain.”

Dr Melvin Look, the director of PanAsia Surgery and a consultant surgeon in gastrointestinal, laparoscopic and obesity surgery, explained that "TRPVI receptors can also be stimulated by other noxious stimuli like heat or acid". "It is essentially a protective reflex to prevent us from consuming harmful substances."

The reason we love spicy food is that the pain produced can induce the release of endorphins, according to Dr Shim. Some people may simply enjoy the sensation of heat and spice on their taste buds. “Capsaicin may also create a temporary sensation of warmth in the body, which some people find comforting,” he said.

There are adverse effects to consider as well. "If capsaicin is ingested in large amounts, it can stimulate the rest of the gastrointestinal tract and produce symptoms such as heartburn, chest pain and abdominal pain. It can also stimulate abnormal gut motility leading to reflux and diarrhoea," said Dr Look.

He added that those with "a history of gastrointestinal problems such as gastroesophageal reflux, gastritis and irritable bowel syndrome are likely to be more sensitive to small amounts of capsaicin".

WHAT’S THE MINIMUM AMOUNT OF CAPSAICIN NEEDED TO START CAUSING STOMACH ISSUES OR EVEN BE FATAL?

About 0.5mg to 1mg is all it takes to kick off capsaicin's mild, unpleasant effects, said Dr Look, citing human studies. "Serious adverse effects (eg. cold sweats, changes in blood pressure or dizziness) start to appear when more than 170mg is ingested" or the "equivalent of eating 1kg of jalapeno peppers", he said. "These symptoms would be extremely unpleasant but they will likely abate in half a day or so."

He added: "In comparison, the lethal dose for capsaicin is estimated to be far higher at around 35,000mg of capsaicin for an adult. You would usually have to force yourself to eat an amount of spice that is far beyond what is generally tolerable. This sometimes happens when people subject themselves to a spice eating challenge".

The level of gastrointestinal discomfort can also increase if you eat chillies that rank higher on the Scoville scale, said Dr Shim. However, “there is no defined minimum level on the scale that could cause gastrointestinal issues”, he said. “This is because everyone may have a different tolerance level due to innate and trained factors such as genetics, personal preferences and cultural influences”.  

CAN WE GET ACUTE POISONING FROM CAPSAICIN LIKE WHAT THE DANISH FOOD AGENCY WARNED?

Ingesting capsaicin “does not normally result in acute poisoning”, said Dr Shim, “unless an extremely high amount is consumed, especially in susceptible individuals.”

“For example, when accidentally inhaled, capsaicin may result in asthma attack or respiratory distress,” said Dr Shim. “It's therefore always best to consume spicy foods in moderation and be aware of one's tolerance level to avoid any adverse reactions.”

CAN WE TRAIN OUR TOLERANCE FOR SPICY FOOD AND EVEN LEARN TO ENJOY THE HEAT?

Whether you find spicy food a pleasure or pain depends on innate and trained factors, said Dr Shim. 

“Innate factors include variation of genetics, taste receptors and pain perception. Trained factors include the repetitive exposure to spicy foods leading to desensitisation and increased tolerance over time. This can also be influenced by cultural background and personal preference of spicy food,” he said.

But whether you'll eventually learn to enjoy spicy food is a different issue altogether, said Dr Look, as nobody really knows why some people enjoy them and others don't. "The fact that other than humans and the tree shrew, all other animals are repelled by the burning sensation of spicy food seems to suggest that this is a cultural and acquired preference."

If you're up for some "training", the best way to quell the burning sensation in your mouth is with a gulp of full fat milk or ice cream, said Dr Look. "The diary protein called casein can bind to capsaicin and takes it away from the thermoreceptors in your mouth."