How Realistic Was the Poisonous Fruit on ‘The White Lotus’?

The White Lotus creators started planting seeds about Thailand’s deadly pong pong tree in the very first episode.

“What am I supposed to do here all week without my phone?” a petulant Saxon asked hotel worker Pam. “Eat a bunch of fruit?” Even then, Pam’s response clearly foreshadowed future events: “We do have a lot of amazing fruit here, but I wouldn’t eat that,” she responded. “That is the fruit of the mighty pong pong tree, and the seeds of the fruit are toxic.”

In the finale, Tim Ratliff tossed the pong pong seeds into the blender—and ended up accidentally poisoning Lochlan, who then recovered. But how realistic was the portrayal? We asked medical toxicologists what to know about the so-called “suicide tree”—and how Lochlan managed to survive.

The “suicide tree” is famous in Southeast Asia

Throughout this season of The White Lotus, Ben Namam has gotten the same text from his friends over and over: “Is this tree real?” It sure is, he told them. The “suicide tree,” as it’s often called—also known as the pong pong tree or, more formally, Cerbera odollam—is widespread in places like India, Thailand, and the Pacific Islands, says Namam, who’s the director of medicinal plants research at San Diego Botanic Garden.

Every part of the pong pong tree is poisonous, but the leaves and barks aren’t as potent as the seeds. It’s long been used for both murder and suicide in Southeast Asia.

It’s perfectly reasonable to think these trees would be growing on the White Lotus property, despite their danger. “People have certainly known for hundreds if not thousands of years that this is poisonous,” he says. If you live in an area where pong pong trees are prevalent, you’d have grown up well-aware of the tree’s dangers. “These are the kinds of things that get taught in the household or potentially even in schools,” Namam says.

It kills by targeting the heart

The tree’s seeds contain cardiac glycosides, which are also found in plants like foxglove and oleander and can have significant effects on heart function. The specific types in the pong pong tree (including cerberin, cerberoside, and neriifolin) are particularly deadly and work by attacking the heart—a huge muscle that requires tiny electric shocks to contract or beat, which then pumps blood to every organ in the body.

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In order for the heart to keep pumping, it needs a combination of specific electrolytes, including sodium and potassium, says Dr. Mary Wermuth, a medical toxicologist at Indiana University Health. These seeds “poison that pump, and then you get electrolyte derangements,” she says. That leads to a slow heart rate, low blood pressure, a disassociation between the upper and lower chambers of the heart, and eventually, death. Ingestion can also cause hyperkalemia, or dangerously high levels of potassium.

It can be a horrible way to die

It’s possible that some people who intentionally ingest pong pong seeds will feel tired and faint as their heart is slowing down, and then they’ll die. But others will experience a brutal end. “There are people who will have hours-long vomiting sessions while their heart is slowly stopping—the body’s trying to get everything out, because it’s being attacked,” Namam says. Some people will “have this massive laxative effect, and they’re just hunched over on the floor throwing up and diarrhea-ing.” There’s no way to predict exactly how someone will be affected, he adds.

Wouldn’t you taste it in a smoothie?

The pong pong tree’s seeds have a “moderate bitter taste,” says Yvan Gaillard, a toxicologist at the Laboratory of Analytical Toxicology in France. Yet it’s easy to mask in a more bitter drink, like coffee, or in a sweet drink. What about a shake, like Lochlan drinks? “No problem,” Gaillard says, “Provided the seeds have been finely ground and added beforehand.”

All that puking was spot-on

In The White Lotus, Lochlan vomited into the pool and then collapsed—seemingly dead. That’s a realistic depiction, says Dr. Joshua King, medical director of the Maryland Poison Center. (King missed the finale because he was traveling home from a medical toxicology conference, where the show’s portrayal of the pong pong tree was a hot topic.)

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Research suggests vomiting is one of the most common symptoms associated with pong pong seed ingestion. “Many different toxins will make you throw up,” King says. “You can almost think of vomiting as our defense system against toxins.” Rats, for example, are incapable of vomiting, which is why rat poison works so well. Humans, on the other hand, are much more likely to start throwing up when they swallow something toxic, he says. Still, throwing up doesn’t necessarily mean you’ve gotten the toxin out of your system—and it could already have affected Lochlan’s heart.

It all happened too quickly

When Dr. Michael Levine, an emergency medicine physician at UCLA Health, watched the finale, a couple plot points stood out to him as most unrealistic. Lochlan appeared to get sick almost immediately after downing the poisoned smoothie, which typically wouldn’t be the case. “The timing is certainly abnormal,” he says. “I wouldn’t have expected in real life for someone to be unconscious, then like 2 minutes later, their father is holding them and saying ‘Come back to me,’ and they’re just fine.”

A more accurate depiction, Levine adds, would be for symptoms to show up at least an hour later. In a case study based on six cases of pong pong seed ingestion reported to U.S. poison centers, Wermuth found that the amount of time between ingesting the seeds and developing symptoms varied. Two patients became symptomatic after three hours, while another took 15 hours to start experiencing symptoms. (Even though the tree does not grow in the U.S., the people in Wermuth’s study ordered pong pong seeds online; they’re so readily available on the internet, she says, that emergency physicians need to be more aware of them.)

So why didn’t Lochlan die?

The Swiss physician Paracelsus once said “the dose makes the poison.” That’s medical toxicologists’ motto, Wermuth says: Everything is poisonous if you consume enough of it. In all likelihood, Lochlan simply didn’t consume a large enough amount of pong pong seeds for it to be lethal.

There’s no single amount of the toxin that’s guaranteed to be fatal. A number of factors make a difference, Wermuth says, including the age of the tree: “Is it a young plant with barely any toxin, or an established plant that has a lot of toxin in it?” Exactly how much will make someone die is “extremely unpredictable,” she says. “It’s not like you told me you took 325 acetaminophen tablets,” she adds. “I could predict toxicity with that. Natural things, it’s a roll of the dice.”

Wouldn’t the rest of the Ratliffs have gotten sick after having a few sips of Tim’s special piña coladas? Not necessarily. “Perhaps they didn’t get enough to induce toxicity,” Wermuth says. It would be reasonable to assume that, if the cardiac glycoside was diluted with other ingredients in the piña colada, nobody would have become symptomatic or died, she adds.

Paging the nearest hospital

Forget heading home to North Carolina: Let’s hope the Ratliffs got Lochlan to the emergency room, stat. Wermuth has a hard time believing he would have survived without immediate intervention. “There’s no good way to get [the toxin] out of your system,” she says, but clinicians typically administer medications used to treat a low heart rate and low blood pressure, as well as high potassium.

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There’s also an “antidote” for pong pong seeds, though Wermuth notes she uses the term loosely. A prescription medication called digoxin contains a dose of cardiac glycoside to help treat heart failure and atrial fibrillation. The medication can “slow down the heart rate,” she says. “But if you get too much of it, then your heart isn’t beating well, and you get cardiac dysrhythmia.” In those cases, patients are given digoxin immune fab, which are antibodies that work “with varying degrees of success.” “They’re derived from poisoning sheep with digoxin, and then you make antibodies that can bind to the digoxin in your blood,” she says. “It helps pull it off the heart.”

Levine agrees that Lochlan would have needed hospital treatment; simply recovering poolside at the White Lotus was unrealistic. “I wouldn’t expect someone to recover that quickly,” he says.

The seeds as a murder weapon

Lochlan was spared from death by the tree’s seeds—which makes him one of the lucky ones.

According to research led by Gaillard, there were more than 500 cases of fatal pong pong tree poisoning between 1989 and 1999 in the southwest Indian state of Kerala. “To the best of our knowledge, no plant in the world is responsible for as many deaths by suicide as the odollam tree,” Gaillard and his team wrote at the time. But they theorized that the actual number of deaths—including both suicides and homicides—was likely much higher, since poisonings are difficult for the average coroner to identify. Only a small number of labs worldwide are capable of identifying Cerbera toxins, Gaillard says, which means the seeds would “remain unidentified in the vast majority of cases.” While Timothy Ratliff might not get away with money laundering, it’s possible no one would have realized Lochlan had ingested pong pong seeds.