Dietary Factors and Supplements

Dietary Factors and Supplements

Foods. Good nutrition is essential for anyone and critical for patients with sickle cell disease. Some dietary recommendations include:

• Fluids are number one in importance. The patient should drink as much water as possible each day to prevent dehydration. Female patients may want to include cranberry juice to help prevent urinary tract infections.
• It is important to have 5 – 9 daily servings of green, red, and yellow vegetables, fruits, or juices that are rich in antioxidants and other important nutrients. Some research suggests that antioxidant foods or supplements (such as vitamins E or C) may help inhibit the formation of the dense cells that trigger a sickle cell crisis. One medical group has created a “cocktail” of supplements and food extracts that are rich in antioxidants and iron-binding compounds that might have more protective effects on the sickling process than single antioxidants. It includes garlic extract, black and green tea extract, pycnogenol, alpha-lipoic acid, vitamin E, coenzyme Q10, and beta-carotene. In any case, patients might eat foods containing these extracts and take supplements of the antioxidant vitamins E and C if their diet does not adequately supply them.
• The chemical resveratrol, which is found in red grape skins, appears to have properties similar to hydroxyurea, the primary drug used in sickle cell disease. Drinking great amounts of grape juice is unlikely to make much difference, but adding it to a child’s diet is unlikely to do harm.
• Protein is important for sickle cell patients.
• Studies on omega-three fatty acids, found in fish and soybean oil, suggest that they might make red blood cell membranes less fragile, and possibly less likely to sickle, although no studies have proven this definitively. Fish and soy products have health benefits in any case. In one small study, fish oil supplements reduced the frequency of painful episodes over the course of a year.

Minerals and Other Natural Substances .

• Zinc. Zinc sulphate appears to help reduce red blood cell dehydration. Important studies indicate that it helps prevent sickle cell crises and reduce pain and life-threatening complications. A study on children with sickle cell suggested that supplements may help improve growth and weight gain. It may also boost the immune system and help protect against bacterial infections. Zinc deficiency is a common nutritional problem in sickle cell disease, so supplements may important.
• Magnesium. Magnesium protects against potassium and water loss in sickle cells. Small studies are reporting promise for its use in preventing dehydration and increasing hemoglobin S concentration.
• Arginine. Arginine is an amino acid that the body converts to nitric oxide, a natural substance that relaxes blood vessels. The sickle cell process reduces nitric oxide levels, which may be responsible for much of the pain in these patients. Arginine and other substances that convert to nitric oxide are being studied in trials.
• L-glutamine is an ordinary amino acid that is heavily used by sickle cells. One study using supplements of this substance reported that after a month it caused positive changes in the blood. Another small study found that daily oral glutamine supplementation improved growth and nutritional measures in children and adolescents with sickle cell disease.

Vitamins. Patients should take daily folic acid and vitamin B12 and B6 supplements. Vitamin B6 may have specific anti-sickling properties. Some experts recommend 1 mg folic acid, 6 microgram vitamin B12, and 6 mg vitamin B6. Foods containing one or all of these vitamins include meats, oily fish, poultry, whole grains, dried fortified cereals, soybeans, avocados, baked potatoes with skins, watermelon, plantains, bananas, peanuts, and brewer’s yeast. Of note, folic acid can mask pernicious anemia, which is caused by deficiency of vitamin B12 and is more common in African-Americans than other populations.