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Origins: The item quoted above, typically titled Star Fruit Can Kill, has been circulating on the Internet since at least May 2008. The original author is unknown to us, but the piece draws its information from April 2008 news reports surrounding the death of Tang Gon Sean, a 66-year-old Malaysian man who on 29 March 2008 passed out after eating star fruits, was taken to Shenzhen General Hospital, and subsequently expired there after falling into a coma. Ten other patients at that same hospital experienced symptoms similar to his, and two died, said Tan Si-Yen, the doctor quoted in those news reports. All had eaten star fruit. Relatively little known in North America, star fruit is popular in China, Taiwan, India, Philippines, Australia, Central America, Africa, and Brazil. While this foodstuff's proper name is carambola, it is more commonly called star fruit because of its shape, which causes slices taken from it to resemble stars. It has a sweet, mild taste somewhat akin to a cross between apple and lime, and is rich in antioxidants and vitamin C. It also has the potential to harm kidney patients. Star fruit contains a neurotoxin that affects the brain and nerves but which people with healthy kidneys are able to filter out; it therefore poses no danger to those whose kidneys function normally. However, those with renal problems lack protection from that neurotoxin and thus risk star fruit intoxication, a condition that manifests with insomnia, hiccups, vomiting, numbness of limbs, decreased muscle power, twitching of muscles, confusion, and convulsions, with the time between ingestion and onset of symptoms varying from thirty minutes to fourteen hours. Intractable hiccups are often the first symptom to present itself. While the majority of those hospitalized for star fruit intoxication do recover, some deaths have been associated with this condition. Star fruit-exacerbated complications in kidney patients are rare, but they are potentially fatal, and thus this fruit is best avoided by those with kidney problems, including those on dialysis. Indeed, dialysis is the only treatment known to be effective in treating this illness, yet it must be both daily and intensive to have the desired effect, and continuous dialysis has been recommended for severe cases. The National Kidney Foundation (NKF) advises in its Dietary Guidelines for Adults Starting on Hemodialysis: Always AVOID star fruit (carambola). Information about the interaction of renal patients and star fruit did not first surface in April 2008; medical literature has been documenting reports of and studies about the star fruit's effect on kidney patients at least since 2000, with such findings subsequently reported by the general media.
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