If you’re mindful of your health, you probably make an effort to enjoy certain foods in moderation. But with one particular dish, even having it once could be risky.

As you age, it’s crucial to make smarter food choices, but there are still certain foods that you might want to avoid altogether.

One Thai dish, in particular, has a deadly reputation, responsible for taking the lives of around 20,000 people annually.

Although the ingredients may not appear harmful at first glance, the backstory of one of its key components reveals a far more dangerous side.

Despite being made from minced raw fish, lemon juice, herbs, and spices, this Thai delicacy is considered a salad by the Lao people living in present-day Laos and Isan.

Koi Pla is a deadly dish that is reportedly consumed by millions each year. However, it’s not the raw fish that causes liver cancer, but rather the source of the fish.

The fish used in the dish are farmed from waters in the Mekong region, which are contaminated with parasitic flatworms. These flatworms are believed to be the cause of bile duct cancer, which is why East Asia has the highest rates of cholangiocarcinoma (CCA) globally.

Dr. Narong Khuntikeo, a liver surgeon, is actively fighting against the consumption of Koi Pla. He tragically lost both of his parents to liver cancer after eating the dish.

“It’s a very big health burden around here,” Dr. Khuntikeo told Agence France-Presse. “But nobody knows about this because they die quietly, like leaves falling from a tree.”