Why eating star fruit is prohibited for patients with chronic kidney disease?

Abstract

New studies have shown the mechanism by which the star fruit (Averrhoa carambola) becomes toxic to individuals with chronic kidney disease (CKD). The aim of this study was to review the current literature on the topic. This is a review article, with publications from 2000 to 2014 available in scientific database. There are reports that neurotoxicity is due to the presence of oxalate in star fruit, but recent findings show that the neurotoxic effect of the toxin is by caramboxin, which appears to inhibit the GABAergic system which is the major inhibitory system in the central nervous system (CNS), involving changes as sobs and confusion, to more serious conditions such as seizures and death. It is important to multidisciplinary action to alert patients with CKD as the prohibition of the star fruit consumption.

Is Excessive Intake of Kamias Fruit (Averrhoa bilimbi) Bad for Your Heath? A Case Report and Review

“…It is highly likely that the problem is under-recognized and underreported. Neurotoxicity following ingestion of Averrhoa bilimbi in a patient with end stage kidney failure has also been reported [4], albeit not as frequent as the neurotoxicity caused by its cousin, Averrhoa carambola (balimbing or star fruit) [5]. Symptoms of neurotoxicity include uncontrollable hiccups, mental confusion and seizures [4,5].…”

“…Neurotoxicity following ingestion of Averrhoa bilimbi in a patient with end stage kidney failure has also been reported [4], albeit not as frequent as the neurotoxicity caused by its cousin, Averrhoa carambola (balimbing or star fruit) [5]. Symptoms of neurotoxicity include uncontrollable hiccups, mental confusion and seizures [4,5]. Although majority of the reported cases of AKI recovered with conservative management, many required acute hemodialysis [6,7,8,9].…”

Nutrients Turned into Toxins: Microbiota Modulation of Nutrient Properties in Chronic Kidney Disease

“…Caramboxin is a nonpeptide amino acid, phenylalanine-like molecule that inhibits the GABAergic system through a glutamatergic ionotropic molecular action, having potent excitatory properties [49]. From 2000 to 2014 neurotoxicity related to carambola ingestion was reported in 110 patients, of whom 27 died [50]. The vast majority had CKD and developed neurotoxicity resulting from accumulation of caramboxin due to reduced renal excretion.…”

“…The amount of fruit consumed ranged from a glass of juice to 4 carambolas and symptoms started between 2 h and 2 days after ingestion. The initial presentations included uncontrollable hiccups (a typical manifestation found in over 90% of patients), vomiting, mental confusion, seizures, coma and death [50]. Daily hemodialysis or continuous renal replacement methods is the therapy of choice for severe cases [53].…”

Enantioselective Total Synthesis of the Neurotoxin Caramboxin

“…Toxic effects due to the consumption of this fruit have been recently reported particularly in patients with chronic renal failure causing vomiting, mental confusion, convulsion, and in some cases the death of the patient. 1,2 Although the mechanism of toxicity is unclear, it involves not only neurotoxicity but also nephrotoxicity, even in people with normal renal function. 1,2 Recently, the neurotoxin caramboxin 1 has been isolated and identified as an active compound responsible for neurotoxicity.…”