By Eduardo Gonzales, MD
Is it true that swallowed tomato and guava seeds can give rise to appendicitis? I also recently read a newspaper article that advises people against swallowing santol seeds. What sort of health problems do swallowed santol seeds pose?
That swallowed tomato or guava seeds can lead to appendicitis is a myth. It is true that in rare instances the deceased appendix that is removed from people with appendicitis contains a tomato seed, but the seed is not the reason for the appendicitis. There is no scientific evidence that links tomato or guava seeds to appendicitis or any health problem for that matter. These small seeds are therefore safe to swallow, besides, how can you avoid swallowing tomato seeds?
Santol seeds, however, are another matter. The santol (Sandoricumkoetjape), wild mangosteen, or cotton fruit is a tropical tree that grows in Southeast Asia. Its spherical fruit abound in fruit stalls all over the country between May and October. Many of these fruits are harvested from local trees, but some are imported, mostly from Thailand (Bangkok santol). The outer covering of the santol fruit consists of an edible fleshy rind that contains a thin and milky sweet to sour juice. Also edible and tastier is the white, translucent, juicy pulp (aril) that surrounds its three to five brown seeds. The pulp often clings tightly to the seeds such that we need to suck the seed to extract the pulp. Sometimes,we suck so hard that we accidentally swallow a seed or two. The seeds effortlessly slide down our throat into our stomach. In the stomach, the seeds’ pulp is completely digested and stripped away exposing the sharp edges of the seeds, which can cause problems when they reach our intestines.
Serious conditions that are caused by santol seeds
Accidentally swallowed santol seed usually pass out harmlessly with the stool. But some people find pleasure in swallowing santol seeds and make it a habit. This is dangerous because sometimes the seeds form a mass that obstructs the intestine. At other times, they perforate the intestine. These are two serious conditions that necessitate surgery.
There is no countrywide data on the number of intestinal obstructions and/or perforations secondary to santol seeds that occur in the Philippines. But Dr. Reynaldo Joson, a surgeon at Manila Doctor’s Hospital, who has been issuing annual advisories against swallowing santol seeds for more than 15 years now, estimates that about 200 Filipinos are operated on because of this dangerous habit every year, and as many as 30 percent of those operated on later die of complications.
Obstruction of the intestine due to swallowed santol seeds occurs when the seeds stick together to form a hard bolus that completely clogs the intestinal cavity, while perforation occurs when the sharp edges of the seeds jab and puncture the intestinal wall. Perforation of the intestine results in spillage of feces into the peritoneal cavity causing peritonitis or infection of the abdominal cavity, a very serious and many times a fatal condition.
The segment of the intestine that is usually affected by swallowed santol seeds is the sigmoid colon, the terminal part of the colon that is near the rectum.
The Bangkok santol is more notorious than the native variety in causing intestinal obstruction and perforation because its seeds are bigger and their edges sharper.
Food value of the santol fruit
Local analysis of the food value of the santol fruit has shown that the fruit consists mostly of water (more than 85 percent by weight) followed by carbohydrate (11.43 percent), fat (1.43 percent), and protein (0.89 percent). It is also a good source of dietary fiber and contains modest amounts of calcium, phosphorus, iron, thiamine, niacin, and ascorbic acid (vitamin C). Hence, eating the rind and pulp of the santol fruit is a healthy practice, but swallowing the seeds poses a health risk.
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