Star Fruit Intoxication

I received a forward email from friend a week ago informing how harmful star fruit is that it can kill! Here is the email content:

Star Fruit Can Kill

Goes by another name….carambola

This fruit can end your life!

This is not an April Fool Joke. But a stern reminder to all my readers. We were advised to have a few servings of fruits a day in order to reap the benefits of fruits right? But obviously this is one big no-no fruit to be excluded from your fruity feast!

In Shenzen, more than 10 people who consumes the star fruit had died. And now a 66-year-old, Malaysian who has been suffering from kidney ailment fell into coma after eating the start fruits. Yes, all it takes is one fruit or 100ml of its juice and the ordinarily harmless star fruit transforms poison in a matter of hours for kidney patients. So does this mean, people without kidney problems should be fine with star fruit! My take: Not at all! Prevention is better right?

Universiti Malaya Medical Centre consultant nephrologist said that star fruits contain a neurotoxin which is not present in other fruits. It affects the brain and nerves. In healthy persons, the kidneys filter it out. But for those with kidney problems, this potent toxin cannot be removed and will worsen the consumers’ conditions.

The symptoms of start fruit poisoning include:

~Hiccups

~Numbness and weakness

~Feeling confused

~Agitation

~Epileptic fits

The risk of death is high if you are having kidney ailments! But healthy individuals should beware of this fruit’s potential toxin too. It could also cripple your vitality if you are not lucky. So don’t take it for granted. It’s better to avoid them. Please pass this news to others.

My first response to it, could it be a hoax? However doubtful, I searched from the Internet and found the original news report. Well, despite of the fact of star fruit intoxication, I can see some other information have been twisted by the person who produced the above article. Often, I hold some disbelief to this kind of forward email concerning health issues because of the way people deliver or spread the information. Some are apparently questionable and at some point misleading but people still ignorantly spread it without think. 

Anyway, back to the topic, this issue did spark my interest so I decided to research more about it.

Star fruit (carambola) is indeed harmful and can be life-threatening to patients who have kidney dysfunctions particularly uraemia. Common symptoms encountered by uraemic patients after star fruit ingestion are:

• persistent and intractable hiccups
• vomiting
• disturbed consciousness of variable degrees (mental confusion, psychomotor agitation)
• decreased muscle power
• limb numbness, paresis and paresthesia
• insomnia
• seizure
• hypertension
• convulsion

According to the experts, as little as one half of the fruit can lead to the symptoms. The time from ingestion to onset of symptoms ranged from 30 minutes to several hours and in some severe intoxication cases, death resulted.

It is said that these symptoms are caused by the oxalic acid and a kind of neurotoxin contained in the star fruit. However, the claim of oxalic acid being problematic in this case is controversial as the other foods that contain higher level of oxalic acid such as spinach do not seem to cause the symptoms. Brazilian researchers Carolino et al. (2003) have proven that the AcTx, a neurotoxic compound found in star fruit, is causal to the convulsion after ingestion. For people with normal kidneys, this compound can be excreted from the blood quickly and thus they do not suffer from its effect when a reasonable portion of the fruit is consumed.

Medical treatment for star fruit intoxication is kidney dialysis. Interestingly, Neto et al. (2003) who studied the intoxication in 32 uraemic patients found those who were promptly treated with hemodialysis (HD), recovered without sequelae; those who were untreated or treated with other form of dialysis, peritoneal dialysis (PD), unfortunately did not survive.

There are always rebound effects after dialysis such as persistent hiccups and consciousness disturbance. One remarkable case study as described in Neto’s research is about a 25-year-old female uraemic patient who initially developed hiccups after consuming a star fruit. The condition was worsened after she consumed another 4 star fruits few hours later and she even vomited. She then received 2 hours of hemodialysis and the symptoms disappeared one hour after the dialysis. However, she suffered from intractable hiccups 2 hours later and the condition persisted until the next day, when she was again treated with 4 hours of hemodialysis. The hiccups were stopped but that was not the end of the story yet. When she returned home, the hiccups started again and caused her a sleepless night although she experienced 10 minutes intervals that were free of symptoms. The following morning she went through another 4 hours of hemodialysis but the hiccups continued to haunt her when she was at home. Good thing was the 10 mins hiccup-free intervals had extended. The hiccups finally disappeared after she received one more 4-hours dialysis and no sequelae has been reported afterwards. Overall, it took 14 hours of dialysis to end her nightmare. Dreadful isn’t it?

Therefore, it’s highly advisable for kidney patients to avoid eating star fruit. While people with normal kidneys have no problem with the star fruit intoxication, do beware of over consumption. My point of view is, it is unnecessary to completely shut your door to the fruit. You still can enjoy it but always keep one rule of thumb in mind: moderation is the key. And that applies to whatever you eat.

 

Painkiller That Nearly Killed A Life

My friend Susan met a car accident two years ago. Although she survived the accident, the impact of the car crash had caused fractures in her lumbar vertebrae. Since then she had suffered from low back pain frequently. To ease her pain, her physician had prescribed some opiates.

After 6 months of therapy and rest, Susan had finally recovered from her injuries and back to work. However, another problem arose without her awareness. During her resting period, Susan had become pretty dependent on her pain medication. She took painkiller whenever she felt discomfort and eventually the painkiller was taken at an even higher dosage than the initial prescription.

She became addicted to the opiate (painkiller) effects that she could not help to withdraw the pain medication even though her initial back injury had healed. The excessive opiate intake had adversely affected her daily life that she became easily depressed and could hardly concentrate in her work. She also suffered from insomnia often and lost weight badly. Struggling with those unhealthy symptoms for about a year, Susan realized she needed to do something before her painkiller addiction could ruin her life thoroughly.

Susan sought treatment for her painkiller addiction at a drug treatment centre called Meditox after doing some online researches and went through a 6-week outpatient opiate rehab program. The drug withdrawal was a successful one. Now Susan is back to a cheerful person as she used to be and has somehow become more motivated and socially active than ever.

I chatted with her online some days ago and she told me about her future plans. Well, looks like she has got great influence from her treatment counselor that she is considering to enroll in counseling services program! Happy ending isn’t it? I wish her the best of luck.

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The Wolff’s Law

I’ve been studying biomechanics these few days, and learned another interesting topic about the bone response to stress.

Wolff’s Law, a widely known bone adaptation theory in the orthopedics, was developed by the German anatomist Julius Wolff in 1892:

The form of a bone being given, the bone elements place or displace themselves in the direction of functional forces and increase or decrease their mass to reflect the amount of the functional forces.

According to Wolff’s Law, bone grows in proportion to mechanical stress. A healthy living bone models and remodels in response to the mechanical stress it experiences so as to produce a minimal weight structure that is adapted to the stresses acted on it.

The changes in bone density, size and shape are the work of two specialized bone cells called osteoblasts and osteoclasts, which respectively form and resorb bone tissue. The bone remodeling occurs throughout life. During the process, resorption precedes formation, so as old bone tissue is replaced by new bone tissue. Remodeling can be in either “conservation mode” with no change in bone mass, or “disuse mode” with a net loss of bone mass characterized by an enlarged marrow cavity and thin cortex. The latter leads to osteoporosis, results from either excessive resorption or inadequate formation. The bone modeling occurs during growth and healing. Unlike remodeling, the osteoblasts predominate the activity (formation) with a net gain in bone mass.

Dynamic mechanical loading causes bones to deform or strain; the larger the loads, the greater the strain. When strain exceeds the remodeling threshold, bone remodeling occurs in conservation mode with balanced resorption and formation. When strain exceeds the higher modeling threshold, the bone modeling occurs, with bone density and mass increased. Disuse mode remodeling is triggered when strain stays below the remodeling threshold, induces a slow loss of bone.

A physically active individual tends to develop denser and more mineralized bones, particularly at the stressed sites. For example, a tennis player has a stronger and denser radius at the racquet-holding arm than the other arm due to the repetitive high stresses exerted on it. Likewise, a trained runner has an increased bone density at the lower extremity due to the high-impact of the running motion. Interesting to note that a competitive swimmer who spends a lot of time in the water however may have less dense bones than a sedentary individual as the buoyant force exerted on the body has counteracted the body weight (gravity).

The law also explains why astronauts suffer from a kind of bone-loss similar to osteoporosis after a long stay in space. Due to the microgravity, the floating human body undergoes a weightless and almost immobile condition. Since no weight is acted on the skeleton and the body do not have to fight the gravity to move about, the bone mass diminishes, hence the strength and the bone mineral density decrease. Bedridden patients and individuals who lead a sedentary or inactive lifestyle tend to have a decrease in bone mass too as a result of reduced mechanical stress and weightbearing activity. The bones become more susceptible to fractures.

In many traditional Okinawan karate-do and Chinese martial arts, body conditioning is crucial as part of the training routine to strengthen muscles and bones, as well as to elevate the pain threshold. Uechi-ryu karate-do emphasizes conditioning on knuckles, forearms, abdomen, tips of toes, dorsal feet, shins, thighs and calves by repetitively blocking and striking the areas to produce slight trauma to them. Other practices like rubbing, knuckle push-ups, rolling a stick on the shin are formulated for conditioning purpose as well. The principle founded by the ancient Chinese masters is the same as the Wolff’s law theory: the bones become denser and stronger after bearing a long period of dynamic mechanical loadings provided by the body conditioning, thus minimize the possible injuries caused by training and sparring.

However, if the applied mechanical loadings are beyond the power of (re)modeling, it leads to fatigue or stress fractures. This problem is very common to athletes who run and jump on the hard surfaces such as distance runners, basketball players, and ballet dancers. The most common affected bones are femur, tibia, navicular and metatarsals. Similarly, martial artists who overtrain themselves may encounter the same problem, when the stresses applied to the bone exceed the bone’s ability to adapt. Therefore it is important for martial artists to ensure the training is done within safe bounds.

Corpus Luteum

While responding to a sparring injuries topic in a martial art forum, I learn about this corpus luteum and I find it an interesting knowledge, so I decide to blog it for better memory, and maybe can share with some readers?

In the menstrual cycle of humans and great apes, the corpus luteum (yellow body in Latin), a temporary endocrine structure, is formed by the remainder of the follicle after the ovulation. Its main function is to secrete the progesterone to maintain the pregnancy if fertilization occurs.

Basically a menstrual cycle of a female human (estrous cycle of animals) can be divided into 4 main phases, which are the menstruation, the follicular phase, the ovulation and the luteal phase. During the follicular phase (preovulation), the secretion of FSH (follicle-stimulating hormone) stimulates the development of several follicles in the ovary. Each follicle contains a oocyte or ovum but normally only one ovum is mature enough to be released during the ovulation. The luteal phase is the second phase of the menstrual cycle and is also known as the post-ovulation. Averagely it starts on the 14th day of a normal 28-days menstrual cycle and lasts for 10 to 14 days. During this phase, the progesterone produced helps to thicken the lining of the uterus or endometrium for implantation and is essential to support a healthy pregnancy.

When the egg is not fertilized, the corpus luteum starts to decay and eventually the production of progesterone stops. The lining of the uterus is then shed off the uterus wall due to the drop of the progesterone level and expelled through vagina during the menstruation.

When the egg is fertilized, the embryo secretes the HCG (human chorionic gonadotropin) to signal the corpus luteum to continue producing the progesterone for maintaining the thick lining of the uterus. The progesterone production by corpus luteum lasts for 10 weeks after ovulation, and eventually the placenta takes over the job to produce progesterone through the end of the pregnancy.

The decay of the corpus luteum leads to the formation of corpus albicans (white body in Latin), which remain as the fibrous scar tissues in the ovary.

Most females know the harms caused by the intense exercise during menstruation but only a little of them are aware of this luteal phase. During the luteal phase, intense exercises such as running, weight-lifting, and other abdominal exercises should be avoided as they instantly rise the abdominal pressure. High abdominal pressure is likely to cause the rupture of the mature corpus luteum. Occasionally, the ruptured site may bleed, resulting in abdominal pain or some signs of hemorrhage. If the ruptured site is capillary-rich, it may lead to massive internal hemorrhage, and cause the hemorrhagic shock or even death; anyway, this kind of case rarely happens.

In my opinion, this is also a potential injury for the female karate-do practitioners, who train for jiyu kumite (free sparring) but so many of them are not aware of it. The impact of a forceful punch or kick in the abdomen instantly rises the abdominal pressure, leading to the rupture of the corpus luteum.

I hope more female sports and martial art enthusiasts will realize the fact and take necessary precautions. After all, prevention is better than cure.

You may find out more here about other potential injuries obtained from the karate kumite training.