Fugu is a Japanese dish prepared from the meat of pufferfish. Because pufferfish is lethally poisonous if prepared incorrectly, fugu has become one of the most celebrated and notorious dishes in Japanese cuisine.

The Japanese poet Yosa Buson (1716-1783) talked about fugu in a famous haiku:

I cannot see her tonight.
I have to give her up
So I will eat fugu.

Puffer Fish contain the poison tetrodotoxin. Tetrodotoxin is a very potent neurotoxin and shuts down electrical signaling in nerves by binding to the pores of sodium channel proteins in nerve cell membranes. The tetrodotoxin is very stable and not affected by the heat of cooking. It does not cross the blood-brain barrier, leaving the victim fully conscious while paralyzing the remainder of the body.

If an ingested dose of the fugu's poison is lethal, as more and more muscles are paralyzed, symptoms may include dizziness, exhaustion, headache, nausea or difficulty breathing. For 50% to 80% of the victims, death follows within four to 24 hours. The victim remains fully conscious throughout most of the ordeal, but cannot speak or move due to paralysis, and soon also cannot breathe and subsequently asphyxiates. If the victim survives the first 24 hours, he or she usually recovers completely.

There is no known antidote, and treatment consists of emptying the stomach, feeding the victim activated charcoal to bind the toxin and taking standard life-support measures to keep the victim alive until the effect of the poison has worn off. Japanese toxicologists in several medical research centers are currently working on developing an antidote to tetrodotoxin.

As mentioned above, commercially available fugu in supermarkets or restaurants is very safe and, while not unheard of, poisoning from these products is very rare. Most deaths from fugu occur when untrained people catch and prepare the fish, accidentally poisoning themselves. In some cases they even eat the highly poisonous liver on purpose as a delicacy. As not all fishes are equally poisonous, this may not always lead to death, but sometimes give little more than the desired numbness on the lips and tongue while eating and shortly thereafter. However, in many cases this numbness of the lips is only the first step of a lethal fugu poisoning.

Some sources claim that about 100 people die each year from fugu poisoning, while others sources say only 10 to 20 per year. According to the Health, Labor and Welfare Ministry, 14 people died of blowfish poisoning between 2002 and 2006. Some of the reported variations may be the result of different sequences of years being studied, as for example in 1958, the first year the preparation of fugu required a special license in Japan, 176 people died of fugu poisoning. According to the Fugu Research Institute, 50% of the victims were poisoned by eating the liver, 43% from eating the ovaries and 7% from eating the skin. One of the most famous victims was the famous Kabuki actor and "living national treasure" Bando Mitsugoro VIII, who requested four servings of fugu liver and died after eating in 1975. The fugu chef of the restaurant could not refuse the request from such a prestigious artist. Subsequently, the chef lost his license for breaking the law.

There are some reports of completely paralyzed but fully conscious victims that were believed to be dead, and woke up a few days later or just before being cremated. In some parts of Japan a fugu victim is put next to his coffin for three days to verify the death. If the body does not decompose, it is not yet dead.

The pufferfish is also reported to be one of the main ingredients used in voodoo to turn people into zombies. According to ethnobotanist Wade Davis, the pufferfish is the key ingredient in the first step of creating a zombie, where the tetrodotoxin creates a 'death-like' state. In the second step, hallucinogens are used to hold the person in a will-less zombie state. There was considerable skepticism to Davis's claims; he was widely accused of fraud, and there has been no final statement as to the veracity of his findings.

Despite all this, it's actually rather tasty! The chef will often leave a tiny bit of poison on the fish so that the your lips tingle and go numb when you eat it!