Star fruit dangers: An innocent treat is a threat to my kidneys

Star fruit: It’s sweet, crisp, bright, refreshing and, for me, potentially deadly.

Starbucks’ Kiwi Starfruit Refreshers (now discontinued), star fruit margaritas, or any other star fruit treats I once enjoyed are all a “no” for me now. Sadly, the fruit, also known as carambola, is something I just can’t consume. Ever.

It’s not because of a severe allergy, but rather the fact that star fruit can be deadly for a person with kidney disease.

I nearly died in September 2020 from atypical hemolytic uremic syndrome (aHUS), a rare disease that’s left my immune system in overdrive since I had asymptomatic COVID-19. The complement system activation with the disease essentially makes my immune system attack my blood, which leads to hemolytic anemia and tiny, organ-damaging blood clots. I suffered through multiorgan failure, leaving permanent damage.

The organs that sustained the most damage were my kidneys. They were functioning at less then 5% when I was admitted to the intensive care unit, and I needed dialysis for five months. Soliris (eculizumab), my aHUS medication, gave my body enough opportunity to heal that I regained another 15% of functionality. My kidney function now hovers between 16% and 20%, but that leaves me in stage 4 chronic kidney disease (CKD), where I’ve been stuck for over four years.

But what does all of that have to do with star fruit?

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Reading the bold print

When I was in and out of a dialysis clinic three times a week, I saw a nephrologist frequently. Clinics tend to load you up with all kinds of paperwork about medical emergencies, port catheter complications, what to drink, what to eat, and so on. After all, kidney failure and dialysis are complicated medical experiences to navigate.

One evening I was in bed reading through my mountain of paperwork, which I’d had for a few weeks. At the bottom of a dietary information sheet were these words in huge, capitalized, bold print: “Do not consume star fruit under any circumstance.” Well, that’s weird, I thought. Surely someone would’ve told me if I couldn’t eat something at all.

There are lots of things I’d learned I couldn’t consume or could only consume in small amounts, including electrolyte sports drinks, alcohol, oatmeal, dark sodas, red meat, Advil, and Motrin, to name a few. That was mainly because they contained nonsteroidal anti-inflammatory drugs, potassium, phosphorus, or other ingredients that tax weak kidneys. But star fruit didn’t contain any of those, as far as I knew.

So off to Google I went, and Google did not disappoint. On every CKD and dialysis website I saw, I found some version of this informative warning: “CKD patients should avoid star fruit consumption.”

It turns out that star fruit contains the neurotoxin caramboxim, which kidneys normally filter out. But my severely damaged kidneys are in no shape to filter out excess toxins. Star fruit nephrotoxicity in patients with acute kidney injury or CKD is well documented, with consequences including confusion, seizures, and even death. And star fruit also contains high levels of oxalates, which can damage low-functioning kidneys.

All of these concerns might seem small, given that star fruit isn’t all that common here in the U.S. But the news was sure upsetting to me. No one had said anything to me about the dangers of star fruit. I first saw the warnings over two months after I’d gotten sick. What if I’d had a star fruit drink in that time? Or purchased some to feed to my young children and gave myself a taste?

Star fruit is the last thing I would’ve suspected to be deadly. When I mentioned that to some of my medical team members, they looked at me as though the dangers were widely known. But when I mentioned it to my chemotherapy nurses, they’d never heard of any such warnings.

I’m happy that I took the time to read the dialysis clinic’s information for me. I could’ve made a horrible mistake without realizing it, simply by purchasing the wrong drink at Starbucks. Now, however, I’ve learned to read everything possible about my disease and its comorbidities, given that even a fun, fruity drink could be a fatal error.

Note: aHUS News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of aHUS News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to aHUS.