Health Professional Explains the Science and Risks of Spicy Food Challenges

Spicy food challenges have surged in popularity in the last few years. These challenges entice participants to push their heat tolerance to the extreme — all for the thrill of online fame or a small cash prize. As millions watch content creators and random people on the streets endure the pain of these ultra-spicy foods, the question arises: what is really happening inside their bodies?

Beyond the entertainment, what are the medical implications of consuming such extreme heat levels? Are these challenges just harmless fun, or do they carry serious health risks?

This report delves into the science behind the burn, exploring the physiological impact of capsaicinoids — the active compounds in chili peppers responsible for their intense heat. While some participants may walk away with nothing more than a red face and a funny video, others could experience significant health issues, from gastrointestinal distress to more severe complications.

Key insights

• Pungency and capsaicinoids. Chili peppers' pungency is measured in Scoville heat units (SHU). The more SHU there are, the higher the potential content of capsaicin and other capsaicinoids in food products containing various chili peppers.
• SHU and perceived pain. The more capsaicinoids are present in food, the more they bind to the pain receptors, thus increasing the perceived pain in the mouth, throat, and stomach.
• Gastrointestinal side effects. Most of the severe adverse effects (abdominal pain/burning, nausea, vomiting, and heartburn) may be experienced by consuming around 0.5–1 g of capsaicinoids. However, the milder adverse health effects of abdominal pain and nausea can also be noted with the intake of as little as 170 mg of capsaicinoids per serving, which is potentially present in all of the reviewed products.
• Other side effects. Limited evidence and case reports suggest that ultra-spicy foods may cause symptoms such as skin rashes, disorientation, psychological disturbances, hyperventilation, chest pain, headache, or in some instances, lead to life-threatening conditions such as esophageal rupture or ischemic attack (type of stroke).
• Drug interactions. People with underlying health conditions and specific medication use should consult a healthcare provider, as reports highlight that chili peppers may interact with specific medications.
• Other ingredients and health. Some brands use artificial colorings, such as Allura Red, which is associated with adverse effects like attention difficulties and behavioral change in children with ADHD.

About the Scoville measurements and chili peppers

The Capsicum genus comprises 31 species and more than 4,000 chili pepper varieties, including jalapeños, Ghost peppers, and Carolina Reapers. All chili peppers share some common compounds called capsaicinoids that provide unique properties.

Capsaicin and dihydrocapsaicin are active compounds comprising approximately 90% of the total capsaicinoids in peppers. Capsaicin and other capsaicinoids are responsible for the pungency and heat of chili peppers. Depending on the specific type of chili pepper, its growing conditions, harvest season, and the dehydration process, the content of capsaicin can vary, thus influencing the pungency.

The capsaicinoids are generally expressed in Scoville heat units (SHU). This scale measures the degree of pungency and heat of a particular pepper. The scale is categorized into five groups:

1. Non-pungent varieties (0–700 SHU)
2. Mildly pungent (700–3,000 SHU)
3. Moderately pungent (3,000–25,000 SHU)
4. Highly pungent (25,000–70,000 SHU
5. Very highly pungent (> 80,000 SHU)

Capsaicinoids, and especially capsaicin levels, are directly related to SHU levels. Higher SHU levels indicate a greater potential content of capsaicin and other capsaicinoids in food products containing various chili peppers. Some literature reviews suggest that 1 gram of capsaicin is equivalent to around 16,000,000 SHU.

Currently, there are no known legally established maximum levels for capsaicinoids in foods. While recent scientific research focuses on potential capsaicinoid benefits to health, the increase in viral spicy food challenges raises concerns about the potential health risks of ingesting high doses of chili pepper-based products. As capsaicinoid levels in foods depend on the manufacturer, consumers should be aware of potential side effects and health hazards from consuming excessive amounts of capsaicin-containing products.

Heat perception as pain

All the reviewed spicy food challenges fall into the last category of the Scoville scale, which is very highly pungent, meaning they contain high amounts of capsaicinoids.

The lowest pungency score of the reviewed challenge brands is 135,600 SHU, found in “Da Bomb Beyond Insanity Hot Sauce.” Meanwhile, the highest SHU count belongs to “Death Nut Challenge Version 3.0 level 5”, with 16,000,000 SHU.

The taste buds do not sense capsaicinoids but instead work by irritating specific receptors in the mouth, throat, and stomach, such as the transient receptor potential channel (TRPV1). Capsaicinoids, such as capsaicin, bind to this specific receptor, usually recognized as a pain receptor. The receptor sends heat signals to the brain, interpreting them as pain.

Thus, the higher the pungency of spicy foods, the more capsaicinoids there are, and the more they bind to the pain receptors, increasing the perceived pain in the mouth, throat, and stomach.

The heat profile and perceived pain also depend on the specific chili pepper. For instance, jalapeños produce a quick, intense heat primarily felt in the front of the mouth, which tends to diminish over time. In contrast, peppers like Habanero, Ghost pepper, and Carolina Reaper often have a delayed onset of heat, typically felt in the back of the throat. This delayed reaction can make the heat feel more intense and cause the burning sensation to persist longer.

Most reviewed “Spicy Food Challenge” products use Carolina Reaper, Habanero, and Ghost pepper as ingredients. Due to these ingredients and a very high pungency of capsaicinoids, the perceived pain interpreted by the brain can be felt in the digestive system, where capsaicinoids irritate the pain receptors. The perceived pain may build up and linger longer than other chili peppers such as jalapeños.

Gastrointestinal side effects

Capsaicinoids, particularly capsaicin, are known irritants that can cause burns and damage to any tissue they contact, including those in the digestive system. This irritation can lead to several gastrointestinal side effects:

• Heartburn
• Abdominal burning/pain
• Gastric mucosal damage
• Nausea
• Vomiting

In fact, a randomized control study highlighted that chili pepper intake significantly increased severe abdominal burning and severe heartburn in Thai adults with non-erosive gastroesophageal reflux disease (NERD). Moreover, another study discussed that chili pepper ingestion may induce abdominal pain and a burning sensation in people with diarrhea-predominant irritable bowel syndrome (IBS-D).

Due to the increased popularity of spicy food challenges, certain federal institutes in Europe released warnings that high levels of capsaicinoids may damage gastric mucosal (protective stomach lining) and promote digestive adverse effects such as heartburn, reflux, nausea, and even vomiting.

While most of the severe adverse health effects, such as abdominal pain, abdominal burning, and vomiting, may be experienced by consuming around 0.5 g–1 g of capsaicinoids, the milder adverse health effects, such as nausea and milder abdominal pain, can also be noted with the intake of as little as 170 mg of capsaicinoids per serving.

Anal burning and anal pain

Anal fissures (small tears in the skin around the anus) and hemorrhoids are especially common in those with a history of constipation. Both of these conditions bring significant discomfort and even extreme pain in some cases. Some scientific evidence suggests that including chili peppers in meals and overall spicy food consumption may exaggerate the symptoms.

A randomized control trial with 50 patients with acute anal fissures reported that the intake of dried chili powder significantly increased the anal burning sensation. Meanwhile, in another study, chili pepper powder alongside antibiotics and analgesics in patients post hemorrhoidectomy (hemorrhoid surgery) also significantly increased pain and anal burning as well as a tendency for more common bleeding was noted.

Lack of clear capsaicinoid information

None of the reviewed products of spicy food challenges provide specific information about the capsaicinoid amounts in grams/milligrams or the specific amounts of chili peppers used.

While the capsaicinoid levels in chili peppers may depend on many factors, they are usually not specified in commercial food products. Meanwhile, high SHU levels on the label of these products can suggest large amounts of capsaicin. For example, the “Death Nut Challenge Version 3.0 level 5” contains 16,000,000 SHU, meaning it may have around 1 g of capsaicin. Similar capsaicin amounts can be estimated in “Johnny Scoville’s Tube of Terror Challenge” by SHU of 13,000,000 highlighted on the label.

Other reviewed products, such as “Toe of the Satan” Lollipop by Flamethrower Candy or “Lil’ Nitro The World’s Hottest Gummy Bear,” contain around 9,000,000 SHU, which may provide around 0.5 g of capsaicin.

These examples align with the capsaicin levels noted in some federal institutes as provoking gastrointestinal side effects.

Other side effects and drug interactions

Some reports show that ingesting more capsicum-containing foods can lead to skin rashes or wheels.

Other reviews even discuss potential systematic toxicity, including disorientation, fear, loss of body motor control, diminished hand-eye coordination, hyperventilation, and even tachycardia (faster heartbeats than regular). Some discuss that the increase in blood pressure due to high intakes of capsaicinoids may also lead to headaches, increased risk of stroke, and even heart attack.

A cross-sectional study with Chinese college students reported that consuming spicy foods a few times per week can increase the possibility of developing anxiety-like symptoms.

Potential mechanisms for adverse health effect occurrence

Capsaicin, found in spicy foods, may affect the nerves that control blood pressure. While it can lower blood pressure by regulating the release of certain neurotransmitters in the body, such as CGRP, high doses of capsaicin can deplete this transmitter, potentially raising blood pressure and causing blood vessels to widen, leading to redness, chest pain, or rashes on the skin.

Moreover, capsaicin may impact nerves in the respiratory system and lungs. C fibers in the respiratory system may react strongly to irritants such as capsaicin, causing inflammation and narrowing the airways, which may provoke coughing and even hyperventilation. Together with increased blood pressure and intensified breathing, other symptoms such as headaches or fight-or-flight mode can be activated, inducing panic and fear.

Extreme side effects in case studies

A few case studies also highlight that very pungent foods, specific chili pepper varieties, and a high intake of capsaicinoids may lead to serious health hazards.

One case study discusses a 15-year-old male’s health complications as a consequence of ingesting Carolina Reaper on a dare. The intake of this chili pepper provoked acute headaches, nausea, and vomiting. The blood pressure was significantly increased after ingesting the ultra-spicy pepper.

Another case reported esophageal (the tube that connects the mouth to the stomach) rupture, which is a life-threatening condition, in a 47-year-old male after ingestion of Ghost pepper.

Finally, an ischemic attack (a type of stroke) was reported for an 8-year-old after eating spicy meals.

Although older scientific reports and case studies may not apply to everyone, cases of severe health issues highlight the potential risks associated with ultra-spicy food challenges like “Toe of Satan,” “Lil’ Nitro,” or “Death Nut.” These challenges, despite their appeal, especially for adolescents and children, may potentially have severe health consequences, as even the brands warn about them on their product labels.

Drug interactions

Some reports suggest potential interactions between chili peppers and certain drugs. Certain Capsicum annuum species may interact with medications such as aspirin or salicylic compounds. Moreover, it may also decrease the action of α-adrenergic blockers, clonidine, and methyldopa.

Artificial colors

For some of the reviewed products, such as “Toe of Satan” or “Lil’ Nitro,” the ingredient list includes artificial colorings, especially the color Red40, also known as Allura Red.

While artificial additives are generally strictly regulated by health authorities and are only allowed to be added to foods at safe levels, growing scientific evidence suggests that regular consumption of higher amounts of these ingredients may have some negative health effects long-term.

Some reports note that the consumption of artificial food colors may increase certain adverse effects, such as behavioral changes and attention difficulties, in attention deficit hyperactivity disorder (ADHD) in children.

Moreover, some animal models suggest that high intakes of Allura Red may lead to liver and kidney toxicity.

Bottom line

While ultra-spicy food challenges are popular on social media and can attract many views, these products also carry significant health risks.

Multiple reports, case studies, and even official governmental institutions warn about the potential side effects of consuming highly pungent foods. While each person is different regarding tolerance to heat, pain, and the impact of spicy food on their bodies, the potential health risks and dangers of extremely spicy food challenges may not be worth the risk.

Article history

Our experts strive to provide up to date information and update articles when new information becomes available

September 05, 2024

Co-written by Sandra Vigelienė, BSc

September 05, 2024

Co-written by Lauryna Nelkinė, MSc

September 05, 2024

Written by Edvardas Garbenis