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More Virginians are foraging for ramps. Many are poisoning themselves by picking the wrong plant.

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ramps or false hellebore

False hellebore, a native species in Virginia, is often found in the same environment as ramps. The stems, roots and leaves are all highly toxic. 

Courtesy of Virginia Mercury

After a dreary pandemic winter, more Virginians are venturing out in search of ramps — the leafy green allium that’s become a darling of the spring dining season.

Sometimes, what they’re finding is poisoning them. Dr. Chris Holstege, medical director of the Blue Ridge Poison Center at UVA Health, said he and his colleagues have been alarmed by a sharp increase in Virginians consuming false hellebore, a highly toxic native species with leaves that — to the uninitiated — resemble the tops of wild leeks.

“This is my 22nd year at the University of Virginia and we’ve only had two cases prior to this past year,” Holstege said. But over the last few months, aspiring foragers have mixed false hellebore into spaghetti sauce, sautéed it in stir fries and sprinkled it over ramen. In the most severe cases, it’s led to hospitalizations, with symptoms including vomiting, cardiac arrhythmias, dangerously low blood pressure and even seizures.

“It has a toxin in it that opens up our neuronal and our cardiac sodium channels,” Holstege said. “The patients that we’ve talked to, they talk about, ‘Yeah, we went foraging, we started to eat it, and our tongues started tingling.’ That’s because your neurons are set off, so you get this weird sensation that only gets worse if you keep going.”

In some ways, the sudden influx of ramp-related confusion didn’t come as a complete surprise. Both locally and nationally, poison centers have seen a roughly 25 percent increase in calls linked to plant consumption. Holstege said the pandemic has driven interest in foraging as a safe, socially distanced activity that gets Virginians out of the house.

But as it turns out, a lot of poisonous species exist in the wild. Holstege remembers a farmer who called the poison center last year after confusing young pokeberry — another toxic perennial that yields dark purple berries — with wild potatoes. It’s even riskier for inexperienced foragers who aren’t familiar with the different stages of plant development.

“We often find it happens when plants are young,” Holstege said. “People will use their phones or use other media to try and identify them, and that’s where they run into problems. Because a lot of times, the plants that are depicted are in their adult, mature form.”


Ramps, also known as wild leeks, are popular table fare in April and May.

That’s what usually happens when it comes to ramps. Just like false hellebore, the wild leeks are often found in wet, forested areas — especially in moist soil near small springs. Technically, ramp bulbs never go dormant, unlike tulips and other onion species, according to Glen Facemire, a Richwood, West Virginia native who recently retired from running one of the only ramp farms in the country.

But the prized green leaves only emerge once a year, in the early spring, and quickly disappear again. Unfortunately, that time of year is when they’re most easily confused with false hellebore, whose leafy shoots sprout cream-colored flowers later in the season.

Adding to the problem is a growing ramp mania that’s fueled awareness of the pungent leeks. Virginians have fallen so hard for the ephemeral edibles that experts are now worried about ramp overharvesting. In the wild, the seeds have about a 95% mortality rate, Facemire said, magnifying concern for the survival of the species.

“The good flavor and everything has got out there to the point where the demand is more than the supply,” he said. Before Facemire retired, he estimated he sold 30 tons of ramps — a total of about 120,000 bulbs and leaves. He’s had to turn down wholesalers who requested a ton every month.

Once better known in rural Appalachia, the leeks have become a seasonal staple in the culinary world. Kyle Morse, who owns a hand-crafted sausage company in Richmond, previously spent a decade cooking in New York City. Over the years, he watched ramps spread from Michelin-starred restaurants to menus all over the city.

Beyond the hyper-seasonality, Morse said, ramps are prized for their versatility. With a flavor that’s often described as a cross between onions and fresh garlic, they’re served pickled, in pestos, on top of pastas, compounded into butter and more. Morse, who was introduced to the ingredient through Boy Scouts, now produces his own seasonal ramp sausage.

“It was like an explosion,” he said. “Before, you really only found them in fine dining restaurants. And then, through social media and chefs going out and starting their own kitchens, it blossomed from there. So now ramps are getting into restaurants that are more approachable to the general public.

That growing awareness has led to trouble for amateur foragers. Morse knows an acquaintance who ended up in the hospital after confusing ramps with the similar-looking — and highly toxic — Lily of the Valley.

The risk with foraging, according to Holstege, is that people tend to eat much more of the dangerous ingredient when it’s incorporated into food. Even children are more likely to be poisoned by a parent feeding them the foraged ingredients than they are to find and consume large amounts of them on their own.

“It’s all about how much of it you eat,” Holstege said. And some dishes can mask early warning signs. He remembers one Virginia man who accidentally foraged false hellebore and served it to his girlfriend in spaghetti sauce.

“When they started to eat, his girlfriend said, ‘Hey, something’s not right about this,’” Holstege said. “He said, ‘No, no, it’s safe,’ and he ate a lot more to show how safe it was.”

The man ended up in the hospital. His girlfriend also got sick, but luckily had eaten much less. “She did better, because she recognized there was something not right,” Holstege said.

detecting ramps

In early spring, ramps (on left) are difficult to distinguish from false hellebore (on right).

In an effort to curb growing reports of plant-related poisonings, the Blue Ridge Poison Center partnered with the Virginia Master Naturalist Program to release an updated guide to toxic native plants. The latest version includes more comprehensive listings and illustrations of plants in different phases of growth. There’s also more detail on what they’re commonly confused with.

But the main takeaway, Holstege said, is that foraging is best left to the professionals. Even experienced hikers and hobbyists can mistake edible species for toxic lookalikes, especially if they’re not familiar with a plant’s appearance throughout the year.

“I think it’s terrific that people are going out and exploring,” he said. “But if you’re foraging things and eating them, you really need to know what you’re doing.”

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