Journal · Wild foods

Pokeweed poisoning, water hemlock and the plants that kill

Before this journal tells you about one nut, berry or root from these mountains, here is how people actually get poisoned by plants like these, and the few plants worth knowing by heart.

Highland Willow · Boone, North Carolina · 8 November 2026

This journal is starting a series on the wild foods of the Blue Ridge and the Appalachian mountains: hickory and walnut, sochan and ramps, elderberry, pawpaw, sunchoke. Cherokee families and the settlers who came after them ate all of these. Some of these plants also have a close neighbour that can put you in hospital, or kill you.

So the safety article comes before the food articles, not after them. Read it once, and keep the phone number.

Three ways it goes wrong

We read the poisoning reports we could find for the plants in this series. They do not share one cause. Most fall into three groups.

The wrong plant. Someone is sure they have found something good, and they are wrong. The water hemlock death and the ramp case below are both in this group.

The right plant, prepared the wrong way. In August 1983, 25 people at a gathering in Monterey County, California, drank juice from wild elderberries that had been crushed "with their leaves and branches". Eleven fell ill and eight were flown to hospital. All recovered. The berries were the right plant. Putting the stems and leaves in the press was the mistake (CDC MMWR).

A child and a berry. In the poke figures we found, it is the most common route. Poison centre records for Kentucky, from the national poison data system, show 1,669 human exposures to pokeweed from 2000 to 2019. The median age was 3, berries were involved in 93.9% of them, and most were mild. No deaths were reported (Woolum et al. 2022, Toxicon).

Being sure doesn't protect you on its own. In both of the wrong-plant cases below, the people were sure of what they had found.

Water hemlock

If you learn one plant from this article, learn this one.

On 5 October 1992, two brothers were hunting wild ginseng in Maine. They dug a root from a swampy area and ate some of it. One of them died about three hours later. The CDC's report calls water hemlock "the most toxic indigenous plant in North America", and says that "a 2-3-cm portion of the root can be fatal in adults". There is no antidote. Treatment is supportive only (CDC MMWR).

Water hemlock (Cicuta maculata) is native to the North Carolina mountains, in wet meadows, ditches and floodplains (NC State Extension). It grows in the same wet ground as elderberry, and its flat white flower heads look like elderberry's. UF/IFAS Extension in Nassau County, Florida, was asked about a plant someone thought was Queen Anne's lace or elderberry. It turned out most likely to be water hemlock, and the reply says the flowers of all three look very similar (UF/IFAS).

Elderberry is a woody shrub and water hemlock is not, but a woody stem alone does not make a plant elderberry. Devil's walking stick, a spiny shrub of the same mountains, also carries big white flower clusters and purple-black berries (NC State Extension). Before you pick any elderberry cluster, check that it grows on a woody shrub and that its leaves grow in opposite pairs, each leaf divided into five to eleven toothed leaflets (NC State Extension). If any of that is missing, leave it.

Poison hemlock (Conium maculatum) is in the same plant family and "may be fatal". NC State lists wild carrot, wild parsnip, parsley, anise, angelica and cow parsnip among the plants it gets mistaken for (NC State Extension).

The ramp that wasn't

In April 2015, a man and a woman foraging on the Appalachian Trail in Union County, Georgia, cooked and ate a plant they believed was ramps. It was Veratrum parviflorum, mountain bunchflower. Both arrived at hospital vomiting, with blood pressure near 87/40 and heart rates near 50. Cooking had not destroyed the poison. Both were discharged within 34 hours. Botanists at the University of Georgia identified the plant from its leaves about two weeks later (Anwar et al. 2018, Clinical Toxicology).

That case is from our own mountains. Further north, false hellebore (Veratrum viride) is the usual culprit. In the spring of 2020, Vermont recorded 22 cases by mid-May, against a typical 0 to 8 a year across Vermont, Maine and New Hampshire together. Seven needed critical care (Seven Days, 2020).

The Northern New England Poison Center's director told Seven Days that real ramps should have a strong onion smell, and her first advice was blunter: "We recommend, really, just don't do it." If a leaf you have crushed does not smell strongly of onion, it is not a ramp. Never taste a plant to find out what it is.

Our advice. Smell each plant on its own, not a handful. Once you've handled one real ramp, the onion smell on your fingers can make the next plant seem right.

One more thing about ramps: in Great Smoky Mountains National Park you may not collect them at all (GSMNP 2026 compendium).

Pokeweed poisoning

Poke sallet is a mountain tradition, and pokeweed (Phytolacca americana) is also poisonous in every part. The Tennessee Poison Center says the root is the most toxic part, and that "as little as 0.5 teaspoonful of the root and 10 or more of the berries" can be a toxic dose. People who eat poke sallet boil the young leaves, pour off the water and boil them again, and the poison centre notes several reports of people falling ill even after doing that (Tennessee Poison Center, VUMC).

If you have small children, poke is the plant to deal with first. The Kentucky figures above show who most often ends up on the phone to a poison centre: toddlers who find the dark purple berries. The Tennessee Poison Center notes that the berries' purple juice "may attract young children".

Our advice. Wearing gloves, pull pokeweed out of yards and play areas where small children spend time (NC State Extension), and bag the roots rather than leaving them where a child or dog can reach them. If a child may have swallowed any wild berry, call Poison Help. Don't wait for symptoms.

Buckeye, the nut that looks like a chestnut

A shiny brown nut on the forest floor, in a tough husk, under a big tree. You might pick it up hoping it is a chestnut. In these mountains it may well be a buckeye.

Yellow buckeye (Aesculus flava) is found mainly in the southern Appalachian mountains. NC State Extension rates it "high severity". The fruits, leaves and seeds are toxic, and it "can cause death in humans, livestock and pets" (NC State Extension).

People here have known about the poison for a long time: in 1775 the trader James Adair described people stunning fish in ponds with a pounded mix of "horse chestnuts", most likely a native buckeye, and roots (Adair 1775, p. 403). NC State notes that Native Americans also made food from the seeds after roasting and soaking them to remove the poison. That took knowledge we don't have, and we don't try it.

Leave every nut you can't name.

Elderberry is a food that needs preparing

Elderberry belongs in this series because Cherokee cooks made pies, jelly and wine from it. NC State Extension lists its fruits, leaves, roots and stems as toxic, and says unripe fruits are much more toxic than fully ripe ones. Cooking helps inactivate the poison (NC State Extension). The Monterey case above is what happens when the green parts go into the press. Ripe berries only, stems and leaves out, cooked.

This series covers the black-fruited American elderberry only. Red elderberry, which grows on the high peaks and has red fruit, is the riskier species, and we don't eat it.

Two more plants worth knowing

Jimsonweed (Datura stramonium). In 1994, two Texas teenagers died after drinking a tea brewed from its roots, taken with alcohol (CDC MMWR, 1995). Nothing in this series calls for it. It is here because making a plant into a tea did not make it safe.

White snakeroot (Ageratina altissima) poisons people at one remove. The National Park Service says milk sickness came from the milk or meat of cows that ate it, and that Nancy Hanks Lincoln, Abraham Lincoln's mother, died from milk sickness on 5 October 1818 in Indiana (NPS). NC State Extension is more careful, and says the plant "may have been the cause of death" (NC State Extension). Either way, a plant can reach you without you ever picking it.

Wild ginger: we leave it alone

Wild ginger (Asarum canadense) is often described online as a seasoning. Laboratory work on Asarum species used as medicine found potentially kidney-damaging aristolochic acid compounds in most samples. One of those samples was a leaf of our own wild ginger, grown at Kew Gardens, and the authors report aristolochic acid I in it "in high amounts", though they give no figure (Michl et al. 2017). That is one sample, not a safe dose. We don't eat it, and we won't recommend it.

What this series does not cover

Mushrooms. Some parks allow a small amount of mushroom gathering, but identification is outside what we can responsibly teach in an article, and the risk is serious. This series doesn't cover them.

Medicine. Where we report that a plant was used as medicine, we are reporting history. We are not telling you it works.

Where you may pick. In a national park, gathering any plant is prohibited unless that park's own rules name it (36 CFR 2.1). Those lists are short and specific and differ from park to park, and national forests have rules of their own. Each article will say what we found for its plants.

Keep this number

Poison Help: 1-800-222-1222. It is free and runs 24 hours a day (Tennessee Poison Center). Call it straight away if you or a child may have swallowed something wild, even if nobody feels ill yet, and especially if it was a wild root. Don't try to make anyone vomit unless Poison Help tells you to. Call 911 at once if someone collapses, has a seizure, has trouble breathing or can't be woken (Poison Control, National Capital Poison Center).

Next in the series: chinkapin, hickory, walnut and the other nuts that fed these mountains.

Questions people ask

Is pokeweed poisonous?

Yes, in every part. The Tennessee Poison Center says the root is the most toxic part, and that as little as half a teaspoon of the root and 10 or more of the berries can be a toxic dose. People who eat poke sallet boil the young leaves twice, pouring off the water, and the poison centre notes several reports of people falling ill even after doing that.

What should I do if my child ate pokeberries?

Call Poison Help on 1-800-222-1222 straight away, even if your child seems fine. Call 911 at once if they collapse, have a seizure, have trouble breathing or can't be woken. Don't try to make them vomit unless Poison Help tells you to. In Kentucky poison centre records from 2000 to 2019, the median age of people exposed to pokeweed was 3, berries were involved in 93.9% of cases, most were mild, and no deaths were reported.

Why is water hemlock so dangerous?

The CDC calls it the most toxic indigenous plant in North America, and reports that a piece of root 2 to 3 cm long can be fatal to an adult. There is no antidote. In Maine in 1992 a man foraging for wild ginseng died about three hours after eating the root. It grows in wet ground in the North Carolina mountains, and its white flower heads look very like elderberry's and wild carrot's.

Are buckeyes poisonous?

Yes. NC State Extension rates yellow buckeye, the species found mainly in the southern Appalachian mountains, as high severity: the fruits, leaves and seeds are toxic and it can cause death in humans, livestock and pets. A buckeye can look like a chestnut on the forest floor. Leave any nut you can't name.

What plant looks like ramps?

In the southern Appalachians, mountain bunchflower (Veratrum parviflorum) put two hikers in hospital in Union County, Georgia, in April 2015 after they cooked and ate it as ramps. Further north, false hellebore (Veratrum viride) is the usual culprit. Real ramps should smell strongly of onion. If a crushed leaf does not, it is not a ramp. Never taste a plant to identify it.

Sources

1. CDC, Morbidity and Mortality Weekly Report. Water hemlock poisoning, Maine, 5 October 1992. https://cdc.gov/mmwr/preview/mmwrhtml/00026056.htm
2. CDC, Morbidity and Mortality Weekly Report. Poisoning from elderberry juice, Monterey County, California, 26 August 1983. https://www.cdc.gov/mmwr/preview/mmwrhtml/00000311.htm
3. CDC, Morbidity and Mortality Weekly Report, 1995. Anticholinergic poisoning associated with an herbal tea, and Jimson weed, Texas, New York and California, 1994. https://www.cdc.gov/mmwr/preview/mmwrhtml/00035694.htm
4. Anwar M, Turner M, Farrell N, Zomlefer WB, McDougal OM, Morgan BW. Clinical Toxicology 2018;56(9):841-845. Veratrum parviflorum poisoning of two hikers, Union County, Georgia, 2015. https://pmc.ncbi.nlm.nih.gov/articles/PMC6086754/
5. Woolum J, Akpunonu P, Johnson M, Webb A. Toxicon 2022;220:106962. Human exposures to pokeweed in Kentucky reported to the National Poison Data System, 2000 to 2019. https://scholars.uky.edu/es/publications/human-exposures-to-phytolacca-americana-in-kentucky/
6. Tennessee Poison Center, Vanderbilt University Medical Center. Toxicology question of the week, 10 June 2002: the toxicity of pokeweed. https://www.vumc.org/poison-control/toxicology-question-week/june-10-2002-what-toxicity-pokeweed
7. Seven Days (Vermont), 15 May 2020. Reported poisonings from a ramp lookalike, quoting the Northern New England Poison Center. https://www.sevendaysvt.com/food-drink/sharp-increase-in-reported-poisonings-from-ramp-lookalike-30392151/
8. NC State Extension Plant Toolbox. Cicuta maculata. https://plants.ces.ncsu.edu/plants/cicuta-maculata/
9. NC State Extension Plant Toolbox. Conium maculatum. https://plants.ces.ncsu.edu/plants/conium-maculatum/
10. NC State Extension Plant Toolbox. Sambucus canadensis. https://plants.ces.ncsu.edu/plants/sambucus-canadensis/
11. NC State Extension Plant Toolbox. Aralia spinosa. https://plants.ces.ncsu.edu/plants/aralia-spinosa/
12. NC State Extension Plant Toolbox. Phytolacca americana. https://plants.ces.ncsu.edu/plants/phytolacca-americana/
13. NC State Extension Plant Toolbox. Aesculus flava. https://plants.ces.ncsu.edu/plants/aesculus-flava/
14. NC State Extension Plant Toolbox. Ageratina altissima. https://plants.ces.ncsu.edu/plants/ageratina-altissima/
15. UF/IFAS Extension Nassau County, 18 July 2017. A reader's question on Queen Anne's lace or elderberry. https://blogs.ifas.ufl.edu/nassauco/2017/07/18/q-walking-along-egans-creek-saw-plant-thought-queen-annes-lace-friend-seems-think-elderberry-ideas
16. Michl J, Bello O, Kite GC, Simmonds MSJ, Heinrich M. Frontiers in Pharmacology 2017;8:215. Aristolochic acid analogues in medicinally used Asarum species, including A. canadense. https://pmc.ncbi.nlm.nih.gov/articles/PMC5439001/
17. National Park Service. Grave site of Nancy Hanks Lincoln. https://www.nps.gov/places/grave-site-of-nancy-hanks-lincoln.htm
18. Adair J. The History of the American Indians. London, 1775, p. 403. https://archive.org/details/historyofamerica00adairich
19. Great Smoky Mountains National Park. 2026 Superintendent's Compendium. https://www.nps.gov/grsm/learn/management/compendium.htm
20. Code of Federal Regulations, 36 CFR 2.1 (2025 edition). https://www.govinfo.gov/content/pkg/CFR-2025-title36-vol1/pdf/CFR-2025-title36-vol1-sec2-1.pdf
21. Poison Control, National Capital Poison Center. Need immediate assistance. https://poison.org/need-immediate-assistance