A sweet, delicious death

Can eating a mangosteen with sugar really kill you?

About a month and a half into my Peace Corps service in Cambodia, I was talking to my training host mother about mangosteens. Previously, I’d mentioned how I’d never seen the fruit in America before and I said I thought they were delicious. So every day for the remainder of my training, she bought me a kilogram of mangosteens, peeled them for me, and insisted I eat them before leaving the dinner table. Which I happily did.

Some mangosteens. 

One day we're sitting around, her with the peeling mangosteens, me with the eating mangosteens, and I ask her if she’s ever eaten a mangosteen with the spicy salt commonly eaten on other fruits.

She laughs and shakes her head no. But then, quite suddenly, her face becomes serious. She takes a half-peeled mangosteen, holds it up, looks me directly in the eyes, and says heavily, 

"Don't ever eat this fruit with sugar on it. You will die."

At first, I thought I didn't understand her because of the language barrier, so I asked her to repeat herself.

"Don't ever eat this fruit with sugar on it. You will die."

Ok. Well that is what she said. What a funny thing to believe, I thought. I wonder if it is a common belief in Cambodia.

Turns out, nearly everyone in Cambodia believes this to be true. After asking several people about it, I decided to ask my language teacher. My teacher is incredibly smart, college-educated, and very willing to openly discuss the cultural and linguistic differences between Cambodia and America. She’d answered countless of my questions already, so I trusted her to explain why this was such a popular belief.

"Why do people in Cambodia think if you eat a mangosteen with sugar, you will die?" I asked her one day after class. 

"Because you will die," she said. 

"No, you won't," I said. "It's a fruit and sugar. Those things can't kill you." 

"I don't know why," she said. "But it's true. You will die." 

“Ok. Well, have you ever seen anyone die from it?” 

“No. Just stories. I don’t know why I believe it, but I do. Everyone does.”

Well that’s just silly. You can't just go believing things that you can't prove. No one could explain why it would kill you, they just accepted that it would. It was irrational, it was unscientific, and it was just plain strange.

The importance of not being the bad guy

Fast-forward six months. I'm reading a book called "Seeing Like a State" by an anthropologist named James C. Scott. I'm going to briefly summarize one of his points, because it’s relevant.

Scott argues that there exists a form of knowledge, which he terms "metis", that is inherently local, practical, and experiential. Metis is often an 'approximate' or 'unwhole' truth, and can look unscientific and irrational when viewed from the outside. But metis always develops from real-world experience, and is thus often valuable knowledge for a given situation.

For example: If you were on a boat in a storm, who would you rather pilot your boat: A guy who has a formal navigational education and has read many books on piloting boats like this one? Or a sailor with years of experience on this particular vessel, in conditions like this? One has rational, scientific information, but the other has "metis". 

His argument is that while you'd obviously choose the experienced sailor, very often in history, governments that have sought to 'plan' various things - cities, agriculture, social interactions - have trusted the educated scientist or bureaucrat and devalued the local knowledge of "metis". They trusted the guy with the degree to pilot their boat, and ended up crashing the whole thing.

So this part of the book got me thinking - what about mangosteens and sugar? This seems like a perfect analogy. Except I'm the one saying, "But science, universally applicable principles, fruit and sugar, it is fine! Your local knowledge is wrong, it’s backward, and it’s unscientific! Just think about it!"

I was Scott’s bad guy, the guy who made the wrong choice. I was on the wrong side. I devalued local knowledge in favor of my own thoughts about knowledge and education. I crashed the boat.

I don’t want to be the bad guy though. So what can I do? Well, I thought, I guess I’ll have to learn about eating mangosteens with sugar.

So... Will eating a Mangosteen with sugar really kill you?

When you Google "Mangosteens and sugar", the first result is a thread from a forum of expats in Cambodia, and the expats are mocking Khmer people for the belief that eating a fruit with sugar would result in death. Not very classy and also, upon reflection, disturbingly similar to what me and my fellow volunteers had done, albeit privately, when we first learned of the belief.

Dig a little deeper though, and you can find one medical study regarding chemicals found in mangosteens called xanthones, and their interactions with insulin and glucose in the bloodstream. To quote from their abstract:

“Taken together, these data demonstrate that [components of mangosteens] attenuate LPS-mediated inflammation and insulin resistance in human adipocytes.”

In other words, mangosteens can actually reduce the insulin resistance of cells in the body, giving them a greater capacity to absorb glucose.

In fact, there are a bunch of "pro-mangosteen” organizations out there - like this one, or this one - that promote the fruit’s consumption to treat or help alleviate symptoms of diabetes. Since the xanthones in mangosteens reduce the insulin resistance of cells, they can actually help diabetics process glucose - provided those patients are still producing small amounts of insulin.

So, wait. It turns out mangosteens are not just “fruit”, but have unique interactions with sugar and insulin. Which raises all kinds of questions. What happens if the patient isn't producing insulin, but their cells become less resistant to it after eating a mangosteen? What happens in cells with normal insulin resistance when they are hit with a Mangosteen (allowing more insulin intake) and sugar (a huge smack of glucose)? What about people who have been insulin-resistant for a long time, but with a Mangosteen and sugar would be less resistant and full of glucose? What about differences in children, or in pre-diabetics, or the elderly, or the immuno-compromised, or…

The list goes on, and I have no idea about any of it. I never even took college-level science. And science is lacking here, as I couldn't find any sort of study about any of these issues. After all, mangosteen consumption isn't that high in the West. Why would science bother?

This is all interesting, but will it kill you?

I have no idea. However, I think a few things are worth noting:

·       Mangosteens affect insulin resistance (and thus glucose intake) when consumed.

·       When consumed with sugar by a diabetic or pre-diabetic, the biological result of that consumption could be manifestly changed by the combinatory effects of the mangosteen and the sugar together, as opposed to taking both separately. It would also be different than eating any other fruit with sugar.

·       Were there to be a biological response, it would likely be acute (shock, dehydration, low/high blood sugar spikes) rather than any sort of chronic condition.

·       Many Cambodians lack proper medical knowledge and facilities to treat diabetic emergencies which would be less severe in the states, meaning a case of abnormally high- or low-blood sugar could be life-threatening.

·       Cambodia has a high and rising rate of diabetes, perhaps partially attributable to the Khmer Rogue. A 2004 study found that up to 25% of adults in Cambodia had some sort of glucose intolerance, and two thirds were unaware of their condition.

So. It seems that in most cases, eating a mangosteen with sugar will not result in death. However, given the fragile balance of insulin and glucose that most diabetics must maintain in order to have good health, and given the high rate of diabetes, particularly undiagnosed diabetes, in Cambodia, it may not be such a good idea for a Cambodian to try it. In fact, it doesn't seem so strange that an undiagnosed diabetic eating a mangosteen with a heap of sugar on top could result in a medical emergency requiring treatment that may not be easily accessible in most parts of Cambodia.

What I learned
In dismissing both my host-mother and my teacher's knowledge out-of-hand, I was exhibiting a bias toward rational, scientific thought that is inherent in almost everyone raised in an educational system developed from Enlightenment principles – i.e., “the West.”

Without much critical analysis, we place implicit trust and faith in the institutions of science and specialization. Which is fine, I'm not saying science is bad. But it’s important to notice that, by its very nature, it is exclusionary. By establishing universal principles and dictums, it becomes rigid and inflexible in many ways. If information doesn’t adhere to the principle, we generally toss out the information rather than re-examine the principle – particularly when it comes to snap judgments about new information.

Of course, science can adapt. It can study mangosteens in more detail, and analyze the compounds and their effects on the body - as that one study did. It requires extensive research, significant funding, and very skilled labor, but it’s possible. Just not very likely.

Before science does any of this, however, and with a much smaller investment, the Cambodian people have noticed a phenomenon and used their experience to develop a practical work-around that bypasses the need to worry about the issue altogether. In this case, the "metis" form of knowledge outpaced the science - and perhaps even inspired the original scientific study in the first place. The knowledge appeared irrational and unscientific, but in fact it was highly situational, practical, and useful. Potentially even life-saving.

When presented with this form of knowledge, I didn't even recognize it as knowledge. I labeled it as superstition or urban legend and tossed it aside. I may not have called it "traditional" and "backward" in my head, but I may as well have for all the serious consideration I gave it.

In doing so, I embodied one of the worst tendencies of Westerners and, by extension, their governments – to impose static and rigid views of what is valuable information and what is not upon other cultures. The most visible example of this practice is in foreign aid organizations, where the paradigm of the developed country sharing skills and knowledge to help the less-developed country presupposes a "better" type of knowledge and skill.

Often, when a Western government comes to share “technical expertise” or “skilled labor”, it is not actually engaging in sharing. Rather, it is engaging in a one-way transfer of knowledge in order to replace a “less-developed” system with a “more-developed” alternative, one which is based on science and reason rather than “traditional practice.” This method of aid can be valuable and helpful, but it also runs the risk of ignoring and destroying local, situational, practical knowledge, which can often be more useful or valuable to those who live in the country.

Part of any aid worker's struggle is to try and avoid falling into this trap. You never want to impose your views on another culture, but often times you can do so without realizing it. I may have come to Cambodia as a teacher, but sugar and mangosteens will help me remember that I should always be a student first.