A 14-year-old teen from Massachusetts died unexpectedly this month after participating in a social media dare known as the “One Chip Challenge”, which involves eating an intensely spicy blue corn chip and attempting to hold out as long as possible before doing anything to relieve the pain. The child’s family is understandably blaming the specific product involved in the challenge, a chip sold by Paqui, an American brand manufactured by Amplify Snack Brands, Inc., which is itself a subsidiary of The Hershey Company. The story, with reactions from family members, healthcare professionals, and Paqui itself, has been all over the news in the past week.

Unlike most social media challenges, which organically gain momentum and only occasionally achieve viral status, the One Chip Challenge began as a marketing strategy developed by Paqui in 2016. The product in question, which has now been pulled from store shelves voluntarily, sold for $10 and consisted of a single chip inside of a coffin-shaped box with a large skull on the front. The chip was manufactured using blue corn, sunflower and/or safflower oil, and sea salt along with some undisclosed amount of Carolina Reaper Pepper and Naga Viper Pepper.

Why are some peppers so spice while others are a bell pepper?

The spiciness of a pepper is determined using a scale originally developed in 1912 by pharmacist Wilbur Scoville. His Scoville heat units (SHU) were initially determined using a rather subjective and bizarro homeopathic assessment that involved trained tasters and their diminishing perception of heat when exposed to serial dilutions of each pepper. For the past 40 years or so, however, high-performance liquid chromatography (HPLC) has been used instead to measure a pepper’s concentration of capsaicinoids, primarily capsaicin.

Capsaicinoids are compounds that bind to TRPV1 receptors* on pain fibers in mammalian tissues, causing burning/stinging pain similar to heat or abrasive injury in skin, eyes, the oral cavity, and GI tract. The severity of this pain is based primarily on the concentration and amount of capsaicinoids involved in the exposure as well as unique individual sensitivities that might have genetic or even psychosocial determinants. The dose, as someone probably says or maybe said at one point, makes the chemical irritant, and when ingested in large enough amounts these capsaicinoids can cause nausea, vomiting, abdominal pain, and even burning diarrhea. Children are particularly susceptible to GI upset from amounts that wouldn’t necessarily cause problems for many larger adults.

With the modern method of determining a pepper’s SHU using HPLC, the parts-per-million concentration of capsaicinoids are multiplied by 16, which for a math reason that I don’t understand is based on the fact that pure capsaicin has an SHU of 16,000,000. For some useful perspective, the boring bell pepper has an SHU of 0 because they contain no capsaicin while the majestic jalapeno has an SHU of 2,500 to 8,000. On the other end of the spectrum of peppers is the Carolina Reaper, a hybrid created by crossing a Red Habanero and a Naga Viper, which has an SHU of nearly 2,000,000.

How spice is the Paqui chip? Pretty damn spice.

When it comes to the Paqui chip there isn’t an official SHU, but because it is produced using Carolina Reapers and Naga Vipers, the latter of which has an only slightly less impressive SHU of nearly 1.4 million, it would almost certainly be extremely high. There are definitely people that can tolerate this kind of heat, and perhaps even enjoy it, but there is a wide spectrum of capsaicin tolerance.

Most if not all people attempting the One Chip Challenge would experience extreme discomfort but would not suffer any serious adverse effects. AOC, to give one of many examples, lasted almost 2 minutes before grabbing a glass of water when she attempted the One Chip Challenge a year ago, but she is an adult and has likely consumed a lot of spicy food in the past. Children are at increased risk in general, but does that truly involve the risk of death in addition to nausea and abdominal pain?

The case of the treacherous tortilla

I do not have access to any pertinent medical records, so the events of this case are entirely based on what family members of the unfortunate child have discussed with the press. It will likely take weeks for an official report from the medical examiner to be completed, and these records are private. Unless the family releases them, we may never know what truly happened. So take this with a grain of sea salt.

On September 1st, a fit and healthy (according to his family) 14-year-old Harris Wolobah went to school in Worcester and at some point early in the day consumed an unknown portion of a One Chip Challenge chip. After the ingestion, he developed abdominal pain and might have passed out, although this detail is not consistently reported and wasn’t mentioned by his mother in any of her quoted statements. He then sought out the school nurse who called his mother to come and pick him up.

Harris went home, and according to his mother he felt better for some period of time before losing consciousness at around 4:30 as he was about to leave for basketball practice. He was transported to a local hospital where he was pronounced dead, seemingly upon arrival although that too is unclear. There is a lot we don’t know. Specific details in the medical record might help to unravel the mystery of his death, and the doctors who cared for him probably have an idea but are unable to speak publicly without permission from the family. They could be just as in the dark as we are, however, and patiently awaiting results of the autopsy.

Could it have been the chip?

All we know with certainty is that Harris had abdominal pain after eating some portion of the Paqui chip. We don’t know with any certainty if he had headache, loss of consciousness (at school), chest pain, shortness of breath, palpitations, blood in his saliva or vomit, nausea or vomiting, diarrhea, new rashes, and the list goes on. We don’t know if he had any predisposing conditions that increased his risk of a complication, such as hypertrophic cardiomyopathy or long QT syndrome.

Harris’ family has stated that he was completely healthy, but it is not at all unheard of for an undiagnosed medical condition to present as sudden and unexpected death, even in seemingly healthy children. Again, all we know with anything approaching confidence is that he had abdominal pain soon after the ingestion, he experienced a period of time where his conditioned improved enough to plan on going to basketball practice, he then collapsed at home and was declared dead fairly soon after.

So what could have happened? His death may have been completely unrelated to the One Chip Challenge. Although uncommon, seemingly healthy teens do sometimes die unexpectedly from undiagnosed cardiac disease that can be structural or related to an abnormal electrical rhythm. He could have had a neurological injury of some kind, such as a ruptured aneurysm or head trauma from a fall. Given his age, general good health, and lack of known complaints other than abdominal pain, the list of causes of sudden death is pretty short, however.

Although cases of death related to capsaicin ingestion haven’t been reported that I could find, there has been the occasional heart attack or cardiac rhythm abnormality temporally associated with taking large amounts of capsaicin through pills used for weight loss. There is also animal data showing that large amounts can plausibly result in acute pathological changes in coronary blood flow, so it is possible. But these reports are exceedingly rare and can’t say with certainty that the capsaicin was the true culprit.

The amount of capsaicin ingested in just one chip, regardless of how spicy it is, would be pretty small. So with an estimated LD-50 in humans of 0.5-5.0 g/kg, it would be extremely difficulty for any human to ingest a lethal amount in one sitting. But this doesn’t mean that the capsaicin, or the chip, didn’t play a role in his death.

A sudden elevation in heart rate and blood pressure caused by intense pain could exacerbate an underlying cardiac condition that predisposes someone to an arrhythmia or an outflow tract obstruction. It could result in the rupture of an aneurysm that was barely holding on. If he had severe vomiting, he could have had a rupture of his esophagus, but the timing doesn’t fit that very well. He could have had a severe allergic reaction to an ingredient in the chip other than capsaicin, resulting in an inability to breath through a swollen upper airway, but the timing is off for that as well.

Frankly given what we know I can’t wrap my head around how there is a direct connection between eating that chip and Harris’ death, with the possible exception of a cardiac complication, though that would be extremely unlikely. Poison Control has weighed in on the issue:

People who eat capsaicin-containing products, including tortilla chips featured in the Paqui One Chip Challenge, often experience mouth irritation, pain, or burning, along with intestinal discomfort. Capsaicin consumption can also cause more serious health problems, including shortness of breath, allergic reactions, chest pain, heart palpitations, and even heart attacks or strokes. Consumption of larger amounts of capsaicin can also cause repeated vomiting that can lead to life-threatening esophageal damage. Because of this, people should use caution when consuming foods or products that contain capsaicin.

Conclusion: We will probably never know what happened to Harris Wolobah

That’s really all there is to say on this. It is possible, though extremely unlikely, that eating even an extremely spicy chip would result in death. The possibility that Harris had an undiagnosed predisposing cardiac condition is intriguing, but is pure speculation. Of course, the likelihood that a 14-year-old child would coincidentally die unexpectedly within a few hours of eating the chip and complaining of abdominal pain is pretty low too. But a lot of unexpected deaths do occur on days where the deceased ate something, after all.

*Developing an understanding of the mechanism by which capsaicin causes pain played a key role in the discovery of specific skin sensors for temperature and touch, as well as the identification of the single gene involved in capsaicin sensitivity, which won the 2021 Nobel Prize in Physiology or Medicine.

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.