Starfruit

Starfruit

Starfruit

Clinical overview

Use

dosage

In clinical studies, 200 g/day of fresh star fruit juice (in 2 divided doses) for 4 weeks was used.

Contraindications

Use is contraindicated in patients with chronic kidney disease (CKD).

Pregnancy/breastfeeding

Avoid using. There is a lack of information on safety and effectiveness during pregnancy and breastfeeding.

Interactions

Starfruit consumption should be avoided in people taking bosutinib, panobinostat, and venetoclax.

Side effects

Cases of oral allergy syndrome and anaphylactic shock have been reported when consuming star fruit.

toxicology

Symptoms of starfruit poisoning are believed to result from excessive stimulation of the gamma-aminobutyric acid (GABA)ergic system. Nephrotoxicity and neurotoxicity have been described in several studies and have been mainly attributed to the parent fruit components carambosine and oxalic acid.

Scientific family

• Oxalidaceae (Sauerklee)

botany

A. carambola is a bushy, round plant that grows up to 9 m tall and is believed to have originated in Sri Lanka. It is a slow-growing, woody plant with a short trunk that can reach 15 cm in diameter. The leaflets are sensitive to darkness and vibrations and fold up in these cases. The five-petaled flowers form clusters and are usually red, purple or violet. The small, dark green fruits turn yellow when fully ripe and have 5 longitudinal ribs that create a star shape when cut horizontally. The plant is cultivated extensively in tropical regions (e.g. Southeast Asia, Malaysia) but is widespread throughout the world. (Muthu 2016) A. carambola should not be confused with Averrhoa bilimbi, which is not suitable for consumption. (Lakmal 2021, Vasant 2014)

Story

Starfruit is a commonly consumed fruit that is used as a cleaning agent and in medicine due to its rust-removing properties. The fruits are crunchy and have a slightly sour, sweet and sour taste. Starfruit can be eaten raw or cooked and is often used to prepare juices, pickles, jams and salads or fermented into alcoholic beverages. Medicinally, various parts of the plant are used in many parts of the world as herbal treatments and in Ayurvedic and traditional Chinese medicine preparations to treat fever, sore throats, coughs, asthma, chronic headaches, diarrhea, fungal skin infections, dermatitis, and bleeding hemorrhoids. (Lakmal 2021, Muthu 2016)

Chemistry

Starfruits are a rich source of insoluble fiber (approximately 60% cellulose, 27% hemicellulose and 13% pectin). The plant is also a good source of antioxidants and contains numerous vitamins and minerals. The three most common minerals are potassium, phosphorus and magnesium, with up to 168 mg, 17.88 mg and 12.05 mg in 100 g of the fruit, respectively. Other detectable minerals include calcium, sodium, manganese, zinc, iron and copper. Vitamin C (25.8 mg per 100 g) and oxalic acid (9.6 mg per 100 g) are the two most common acids, followed by tartaric acid, ketoglutaric acid, citric acid, vitamins B1 and B2, gallic acid and carotene. Extracts from leaves, fruits and roots contain saponins, flavonoids (i.e. proanthocyanins), alkaloids, tannins, phytosterols and pyrogallic steroids as well as phenols (i.e. anthocyanins, anthocyanidins), chalcones, aurones, leucoanthocyanidins, catechins etc. Triterpenoids (i.e. saponins). The composition of nutrients varies with the maturity of the plant and fruit. (Lakmal 2021, Muthu 2016, Vasant 2014)

Use and Pharmacology

Analgesic effect

Animal data

In a mouse pain model, star fruit extract administered intraperitoneally inhibited both neurogenic pain and inflammatory responses. Antinociceptive effects appeared to be secondary to anti-inflammatory effects; The reductions in paw edema observed with polysaccharides extracted from starfruit were similar to those observed with the positive controls meloxicam and indomethacin. (Leivas 2016)

Anti-inflammatory effect

Clinical data

Twenty-nine healthy subjects (mean age, 72.4 years; range, 54 to 87 years) who consumed 100 g of fresh starfruit juice twice daily for 4 weeks experienced a significant reduction in some proinflammatory cytokines (i.e., tumor necrosis factor alpha). [TNF-alpha]interleukin 23) and nitric oxide (NO) were observed (both P < 0.001 compared to weeks 0 and 2 of the control period). (Leelarungrayub 2016a)

Antioxidant effect

Clinical data

A preliminary study conducted on 27 Thai subjects (mean age, 69.5 years; range, 56 to 85 years) who received 100 g of fresh starfruit juice twice daily for 4 weeks showed significant improvements in 3 of 4 oxidative stress parameters (i.e., total antioxidant capacity). , malondialdehyde, protein hydroperoxide; P<0.05 for each). Furthermore, consumption of star fruit juice resulted in a significant increase in serum levels of vitamins C and A, but not E (both P < 0.05). (Leelarungrayube 2016b)

Exercise ability

Clinical data

In 29 healthy volunteers (mean age, 72.4 years; range, 54 to 87 years) who consumed 100 g of fresh starfruit juice twice daily for 4 weeks, a significant increase in physical performance (6-minute walking distance) was observed at week 6 ( P < 0.0001 versus weeks 0 and 2). TNF-alpha levels were negatively correlated with exercise performance, while a positive correlation was observed with NO levels (P = 0.027 and P = 0.004, respectively). (Leelarungrayub 2016a)

Fluoride toxicity

Animal data

Fluoride-induced carbohydrate, liver, lipid and antioxidant changes in rats were dose-dependently ameliorated or ameliorated by oral administration of star fruit powder. (Vasant 2014)

Lipid effects

Clinical data

Significant improvements in high-density lipoprotein and low-density lipoprotein cholesterol were observed in 27 Thai subjects (mean age, 69.5 years; range, 56 to 85 years) who consumed 100 g of fresh starfruit juice twice daily for 4 weeks (P = 0.03 and P = 0.02 compared to weeks 0 and 2, respectively). Changes in triglycerides and total cholesterol were not significant. (Leelarungrayube 2016b)

dosage

In clinical studies, 200 g/day of fresh star fruit juice (in 2 divided doses) for 4 weeks was used. (Leelarungrayub 2016a, Leelarungrayub 2016b)

Pregnancy/breastfeeding

Avoid using. There is a lack of information on safety and effectiveness during pregnancy and breastfeeding.

Interactions

Inhibition of CYP3A enzymes has been demonstrated in in vitro and in vivo studies. (Vasant 2014)

Bosutinib: Starfruit may increase serum concentrations of bosutinib. Avoid combinations. (Bosulif November 2014, Bosulif July 2015, Hidaka 2004, Hidaka 2006, Zhang 2007)

Panobinostat: Starfruit may increase serum concentrations of panobinostat. Avoid combinations. (Farydak February 2015, Hidaka 2004, Hidaka 2006, Zhang 2007)

Venetoclax: Starfruit may increase serum concentrations of venetoclax. Avoid combinations. (Venclexta April 2016)

Side effects

A case of oral allergy syndrome (itching/burning in the lips, mouth, and ear canal) was reported in a Japanese pastry chef within 15 minutes of eating star fruit. Her medical history was positive for severe atopic dermatitis, cedar and cypress dust, and mild asthma. She had previously had a similar reaction after eating kiwi and papaya. Skin sensitization to star fruit via atopic skin has been suspected. Immunoblotting assays revealed no cross-reactivity of star fruit with cedar, cypress, kiwi, or papaya. (Numata 2015)

A case of anaphylactic shock to starfruit was reported in a 58-year-old man within minutes of first consuming 4 pieces of starfruit. His medical history revealed no evidence of other food reactions and anaphylaxis. Racing pigeons was considered a hobby; Immunoblot assays showed cross-reactivity of star fruit proteins with seed proteins in pigeon diet. Sensitization to starfruit has been suspected through routine handling of birdseed. (Vazquez-Revuelta 2021)

One case series included adults with and without comorbidities who presented to the hospital with acute kidney injury after consuming 3 to 6 star fruits. The most commonly reported symptoms following acute starfruit poisoning were nausea, vomiting, and abdominal/back pain with subsequent reduction in urine output and an increase in serum creatinine levels over hours to days. Nephrotoxicity was found to be due to tubular obstruction caused by calcium oxalate crystals. Urinalysis of all 4 patients showed oxalate crystals. Compared to the “sweet” star fruit, the “sour” star fruit is known to contain more oxalate. All patients recovered within one month of discharge. (Herath 2021)

toxicology

Symptoms of star fruit poisoning are believed to be due to excessive stimulation of the GABAergic system and include hiccups, impaired consciousness, confusion, incoherent speech, vomiting, psychomotor agitation, insomnia, paresthesias, muscle weakness, epileptic seizures, hypotension, shock, coma, and death. (Aranguren 2017) The neurological appearance can mimic a stroke and can be misinterpreted as such. (Alessio Alves 2012)

Nephrotoxicity and neurotoxicity have been described in several studies and have been mainly attributed to the starfruit components carambosine and oxalic acid. Caramboxin is a renally secreted neurotoxin that crosses the blood-brain barrier, while oxalate causes direct corrosive damage to the gastrointestinal tract and subsequently obstructs the renal tubules through the formation of oxalate crystals. (Aranguren 2017, Stumpf 2020) In a systematic review, 123 cases of nephrotoxicity were analyzed in connection with star fruit poisoning; 80% of these occurred in patients with chronic kidney disease, of whom 27 died. In the remaining 20% ​​of patients with previously normal renal function, consumption was associated with acute nephropathy; 1 patient died, 3 developed chronic kidney disease, and 2 required dialysis. Neurological symptoms have been reported to be more severe in patients with pre-existing chronic kidney disease. (Aranguren 2017)

Treatment depends on the clinical presentation, with hemodialysis being the most reasonable approach, particularly when neurological symptoms are present. There is little evidence to support the use of more conservative treatments (e.g. prednisolone, urinary alkalinization, diuretic therapy), and peritoneal dialysis does not appear to be effective in more severe poisonings. (Stumpf 2020) Animal studies suggest that administration of N-acetylcysteine ​​can alleviate starfruit-induced renal dysfunction, possibly by reducing oxidative stress and normalizing redox status. (Shimizu 2017)

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been evaluated for safety or effectiveness by the FDA and is not subject to the quality and safety information collection standards that apply to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not confirm that this product is safe, effective, or approved to treat any patient or medical condition. This is just a brief summary of general information about this product. It does NOT contain all information about the possible uses, instructions, warnings, precautions, interactions, side effects or risks that may apply to this product. This information does not constitute specific medical advice and does not replace the information you receive from your healthcare provider. You should speak to your doctor to get complete information about the risks and benefits of using this product.

This product may interact negatively with certain health and medical conditions, other prescription and over-the-counter medications, foods or other dietary supplements. This product may be unsafe if used before surgery or other medical procedures. It is important to fully inform your doctor about the herbs, vitamins, minerals, or other supplements you are taking before any surgery or medical procedure. With the exception of certain products generally considered safe in normal amounts, including the use of folic acid and prenatal vitamins during pregnancy, this product has not been adequately studied to determine whether it is safe for use during pregnancy, breastfeeding, or in those younger than 2 years of age.

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