Sugar apples: almost all of the evidence is about a cousin

Almost none of the research collected here is about the sugar apple itself. What exists is a small set of studies on relatives in the same genus, and the difference matters, because they are different fruits. The strongest single study is a randomised trial in Indonesia among 143 adults with prehypertension and high-normal serum uric acid. The group given two 100 g servings of soursop juice a day for three months ended with a lower mean systolic blood pressure than the control group. That control group was given nothing rather than a placebo drink, so expectation and the act of drinking juice are not separated from the fruit, and the abstract reports no effect size and no confidence interval. Soursop is Annona muricata, a relative of the sugar apple. The safety signal is about that same relative. The European Food Safety Authority reviewed Annona muricata food supplements in 2020, found strong indications of neurotoxic potential for certain preparations, and could not set a safe intake level. The findings that point at this fruit directly are about allergy, they appear under the name custard apple, and they come from a report of two patients.

The numbers, per 100 g

What it does to your health

• In a randomised trial of 143 adults with prehypertension, the group given two 100 g servings of soursop fruit juice a day for 3 months had a lower mean systolic blood pressure than an untreated control group. Soursop is a relative of the sugar apple and not the same fruit. — 143 adults with prehypertension and high-normal serum uric acid, drawn from a 4190-person population dataset in Indonesia (n = 143) Evidence B source
  Significantly lower mean systolic blood pressure in the juice group than in the untreated control group across examinations at baseline, week 6 and week 12, with no effect size or confidence interval given in the abstract

Safety, limits and interactions

• A report of two adults with latex sensitisation presented custard apple and aubergine as the offending foods, and in both cases the diagnosis rested on the clinical history, a positive skin prick test and specific IgE to the food. — two adults with latex sensitisation whose offending foods in this report were custard apple and aubergine, worked up with skin prick tests and specific IgE (n = 2) Evidence C source
  Positive skin prick test and specific IgE to the offending food alongside positive tests to latex, avocado, banana and chestnut
• In that same report, specific IgE immunodetection found a reactive 45 kd band in a crude custard apple extract, which anti-chitinase monospecific antibodies also recognised. — serum from that two-patient report, tested against a crude custard apple extract Evidence D source
  A single reactive band of 45 kd in crude custard apple extract, also recognised by anti-chitinase monospecific antibodies

What people believe that the data does not support

• The one randomised trial of Annona leaf extract in people gave it to 30 colorectal cancer patients for 8 weeks and measured how their serum killed cancer cells in a dish, which is not the same as measuring whether the cancer changed. — 30 outpatients with colorectal cancer after primary tumour resection, 28 of whom completed the trial (n = 30) Evidence B source
  Higher cytotoxicity of serum against colorectal cancer cell lines in the supplemented group than in the placebo group, with tumour outcomes not reported
• Among 150 cancer patients in Trinidad who used herbal remedies, 80.7% used soursop regularly, which is how widely the Annona cancer belief travels without a trial behind it. — 150 prostate, breast and colorectal cancer patients attending two specialty oncology clinics in Trinidad who reported using herbal remedies or functional foods (n = 150) Evidence C source
  80.7% used soursop leaves, bark, fruit and seeds regularly, the most popular remedy in the survey

What is still unknown

• In 160 parkinsonian patients in Guadeloupe, eating soursop was more common than in controls, and soursop is a related Annona species rather than the sugar apple itself. — 160 patients with parkinsonism in Guadeloupe classified by neuropsychological testing and MRI, compared with controls and with Parkinson disease patients (n = 160) Evidence C source
  Soursop consumption significantly greater in the PSP-like and parkinsonism-dementia groups than in controls and Parkinson disease patients
• The European Food Safety Authority looked at Annona muricata food supplements in 2020, found strong indications of neurotoxic potential, and said the evidence was too thin to set any safe intake level. — people taking Annona muricata based food supplements, as assessed by EFSA across the published toxicological and human literature Evidence E source
  No safe intake level could be established, with strong indications of neurotoxic potential for certain preparations

The bottom line

The belief that this family of fruit treats cancer is popular and untested. Among 150 cancer patients in Trinidad who used herbal remedies, 80.7 percent took soursop leaves, bark, fruit and seeds regularly, which measures how widespread the belief is at two clinics on one island and says nothing about whether it does anything. The one randomised trial of an Annona preparation in patients gave leaf extract to 30 colorectal cancer outpatients after tumour resection for 8 weeks, and 28 of them finished. What the supplemented group showed was higher cytotoxicity of their serum against cancer cell lines in a dish, with tumour outcomes not reported. That is a laboratory surrogate in a small short trial of leaf extract, not the fruit. The allergy evidence comes under the name custard apple. A report of two adults with latex sensitisation presented custard apple and aubergine as the offending foods. In both cases the diagnosis rested on the clinical history, a positive skin prick test and specific IgE to the food, alongside positive tests to latex, avocado, banana and chestnut. Custard apple had been linked with latex sensitisation in two earlier cases. A report this small shows the reaction exists and says nothing about how often it happens, and four further custard apple allergy reports have no abstract text to quote. Laboratory testing of serum from that report found a single reactive band of 45 kd in a crude custard apple extract, which anti-chitinase antibodies also recognised. Supplements are a separate question from fruit. The European Food Safety Authority reviewed Annona muricata food supplements in 2020, reported strong indications of neurotoxic potential for certain preparations, and could not set a safe intake level, naming the absence of long-term studies as the reason. In Guadeloupe, 160 patients with parkinsonism reported eating soursop more often than controls and people with Parkinson disease did, in a cross-sectional study of a related species where diet was recalled after diagnosis. We found no trial of sugar apple fruit itself, and no data here on portion size, cooking, storage or interactions with medicines.

Sources

1. sapl-r1-04 · randomised controlled trial
   For a 3-month period, the treatment group was given 2 × 100 g soursop fruit juice per day and the control group was not treated. Using the JNC 7 guideline, the treatment group showed a significantly lower mean systolic BP after being adjusted by three times of examinations (baseline, week 6 and 12) compared with the control group.
   J Hum Hypertens, 2020 · checked 2026-09-24
2. sapl-r1-02 · case series
   We present two of these vegetables, custard apple linked in two previous cases with latex sensitisation, and aubergine, that had not been described up to now in patients with latex sensitisation. The diagnosis of both cases was based on the clinical history, positive skin prick test (SPT) and specific IgE to the offending vegetables, as well as to positive SPT and specific IgE levels to latex and the major fruits involved in the latex-fruit syndrome (avocado, banana, and chestnut).
   J Investig Allergol Clin Immunol, 2005 · checked 2026-09-24
3. sapl-r1-03 · in vitro immunodetection
   Specific IgE immunodetection uncovered a reactive band of 45 kd in the crude custard apple extract, which was also recognized by anti-chitinase monospecific antibodies.
   J Investig Allergol Clin Immunol, 2005 · checked 2026-09-24
4. sapl-r1-05 · randomised controlled trial
   Thirty outpatients with colorectal cancer who had undergone primary tumor resection were enrolled in a randomized double-blind placebo- controlled pre-post-trial...Ex vivo and clinical studies showed higher cytotoxicity in the supplemented group compared with the placebo group.
   Asia Pac J Clin Nutr, 2017 · checked 2026-09-24
5. sapl-r1-06 · cross-sectional survey
   Among the 150 patients who reported use of herbal remedies/functional foods, soursop (Annona muricata L.) was the most popular; with 80.7 % using the leaves, bark, fruit and seeds on a regular basis.
   BMC Complement Altern Med, 2016 · checked 2026-09-24
6. sapl-r1-01 · cross-sectional study
   evaluate to what extent a candidate aetiological factor, the mitochondrial complex I inhibitor annonacin contained in the fruit and leaves of the tropical plant Annona muricata (soursop) plays a role in the neurological syndrome...Consumption of soursop was significantly greater in both PSP-like and PDC patients than in controls and Parkinson's disease patients.
   Brain, 2007 · checked 2026-09-23
7. sapl-r1-07 · agency risk assessment
   The present data provide strong indications of neurotoxic potential of certain A. muricata preparations...The paucity of adequate studies, particularly related to long-term use of A. muricata supplements, currently does not allow the establishment of a safe intake level.
   EFSA Journal, 2020, risk assessment of Annona muricata in food supplements · checked 2026-09-24