Eating Well to Combat Sickle Cell Anemia

Sickle cell Anemia or Sickle Cell Disease (SCD) is a recessive condition in which red blood cells become sickle-shaped and fragile. It is a genetic autosomal red blood cell disorder that causes blood cells to take on a crescent shape. Sickle cell anemia patients often experience episodes of pain, fatigue and frequent infections. The disorder is associated with low calcium intake, vitamin D deficiency and poor appetite. All of these can lead to delayed growth, cell repair and development, especially in children.

As a result, hemolytic anemia is observed due to increased red blood cell adhesion and retention.

Here are few dietary recommendations to eat well to combat sickle cell anemia:
Majority of patients are deficient in essential micronutrients and a diet emphasizing fruits, vegetables, whole grains, and legumes will provide a greater proportion of essential nutrients and appropriate supplementation (1-3 times the recommended intakes for most essential nutrients) can prevent deficiency and may decrease the likelihood of severity of symptoms.

• High-calorie, nutrient-dense diet.

Due to poor appetite, the average energy intake of sickle cell patients is typically kept lower than the suggested allowance for calories during the quiescent phase of the disease, and it drops to roughly half the recommended levels during times of illness and hospitalization. High calorie foods like those rich in carbs and proteins are potatoes, tofu, green leafy vegetables and legumes.

• Adequate fluid consumption

Sickling of erythrocytes is greater in SCD patients who exercise in the heat without consuming enough fluids, compared with those who stay well-hydrated.

Dietary guidelines for maintaining good hydration levels include limiting high sodium, processed foods, and snacks while consuming water and fluids throughout the day. Drink variety of soups, juices, lemonade, smoothies and fruity shakes.

• Enough Vitamin D and Calcium

Vitamin D is essential for calcium homeostasis and essential for bone mineralization. Vitamin D deficiency is common in sickle cell disease due to dark skin pigmentation, limited sun exposure, increased catabolism and reduced nutrient and energy intake. Increased exposure in sun and Vitamin D fortified milk, natural sources like egg and fishes are some of the ways to consume Vitamin D. Get a calcium-rich diet including low-fat or fat-free milk, soy, yogurt, and cheese, leafy green vegetables and soymilk, orange juice and tofu.

• A good dose of micronutrients.

Levels of vitamin A and carotenoids, vitamin B, vitamin C, vitamin E, magnesium and zinc, are often low in individuals with SCD. These deficiencies cause a significant depreciation in blood-antioxidant status in these patients, and the resulting oxidative stress and may aggravate the pain. Generally, supplementation of zinc, magnesium, vitamins A, C, and E or treatment with a combination of high-dose antioxidants can reduce the percentage of irreversibly sickled cells. Antioxidant present in dark colored fruits and vegetables such as flavonoids which may also reduce the oxidative stress in SCD. Eat from a rainbow of fruits and vegetables paired with a combination of grains, proteins (such as eggs, fish, chicken, lean meat, beans or tofu) and nuts.

• Not to forget omega-3 fatty acids

The serum phospholipids of children with SCD contain reduced levels of both the parent (alpha-linolenic acid) and the long-chain omega-3 polyunsaturated fatty acids (eicosapentanoic acid [EPA] and docosahexanoic acid [DHA]). These long-chain omega-3 fatty acids increase the fluidity of red blood cell membranes, which may prevent sickle cell crisis. It showed significant therapeutic benefits including reduction of severe anemia. Sources like nuts and seeds including walnuts, almonds, chia seeds, flaxseeds are benefcial to consume.

For people with iron overload due to frequent transfusions, supplements containing iron should be avoided. Nutrition consultation for assessment, to advise patient regarding specific dietary recommendations, and follow-ups should be done on regular intervals. In some cases, protein-calorie supplements are also recommended as per nutrition consultant.

Over to you

Adequate nutrition can help provide a relief to the condition and moreover ensures healthy growth and cell development in patients with sickle cell disease and may reduce the risk of complications in both children and adults. Consult a registered dietitian who can advise the patient and family on how to meet macronutrient and micronutrient needs. Supplemental nutrients may be required as per the physician’s advice.