Of nutritional management for Thalassemia patients

Thalassemia is a type of blood disorder with an autosomal recessive blood problem people suffer from one generation to the other. It causes negative effects of Hemoglobin Formation on the body causing mild anemia. It makes the people vulnerable to every type of problems like bone weakness, cardiovascular illness, iron overload, Liver, Bones, Forehead, Cheeks and Spleen Enlargement, Jaundice, less body fat and less immunity, Puberty delation etc.

Thalassemia is a common problem in Bangladesh. About 10-12 per cent of the population are carriers. Two Thalassemia carriers getting married is not a rare event, given the high prevalence rate. According to the World Health Organisation (WHO), about 4.8 million people in Bangladesh are now carrying the gene of this silent killer disease. It is estimated that approximately 6000 babies with different types of thalassemia are born in Bangladesh each year.

The World Thalassemia Day was observed this year on May 8. It is observed to increase the awareness of common people and doctors to motivate and encourage the youths to donate blood and undergo pre-marriage test to diagnose this problem and prevent the disease from getting inherited by the new generation and encourage government organisations to develop more health care facilities in vulnerable areas.

Nutritional deficiencies are common among thalassemia carriers due to hemolytic anemia, increased nutritional requirements and morbidities such as iron overload, diabetes and chelator use. Thalassemia is a complex condition and the ideal diet planning would require taking into account many factors. The most important thing is: Patients have an Iron Overload problem due to regular Blood Transfusion. For non-transfused thalassemia patients, folate supplementation is recommended, and consuming a moderately low-iron diet is encouraged. For transfused patients on chelation therapy, a low-iron diet is unnecessary and may decrease the quality of life for some patients. Counseling patients to consume a diet low in iron has been part of the standards of care for decades.

Foods high in iron contents are mainly dairy products, almonds, nuts, sesame seeds, tuna, oranges, soybeans, white bread and rice, cabbages, cauliflowers, beet, carrots, celery, cucumber, garlic, lettuce, tomato, potato, apple, pomegranate, strawberry, pineapple and lemon. On the other side, Thalassemia Minor/Anemia Patients who have any iron deficiency problem should consume more of these Iron-rich foods: Samples of Iron Amount in Food (mg) are as follows: Broccoli ½ cup boiled (0.7), Peas ½ cup boiled  (1.3), Vegetables, green leafy, ½ cup ( 2.0), Beef three ounces ( 2.3 to 3.0), Oysters ¾ cup ( 3.0), Liver (beef, chicken), three ounces ( 8.0 to 25.0).

Very high iron sources are found in oysters, liver, bean, beef, tofu, grains like infant cereal, watermelon, spinach, leafy green vegetables, dates, raisins, broccoli, peas and chocolate. Foods that increase non-meat iron absorption is Vitamin C-rich foods, meat, poultry, fish, seafood, pickles, soy sauce, vinegar, alcohol etc.

The adequacy of dietary intake of many important nutrients including protein, calcium, vitamin D, folate, trace minerals (zinc, copper, selenium) and antioxidant vitamins (E and C) should be considered. In Thalassemia, because of the excess iron in the body, there is a higher risk of oxidative damage. So, patients need antioxidants-rich food. Four main antioxidants are Vitamin E, Vitamin C, Carotenoids and Flavonoids.

Non-transfused thalassemia patients are encouraged to drink different type of tea with meals, which decreases iron absorption. Do not cook with cast iron cookware because iron from the cookware can transfer onto the food.

Thalassemia is a preventable disease. The disease only occurs when both the parents carry the thalassemia gene. Thus, if a carrier avoids marrying another carrier, birth of a diseased child can be prevented. This simple awareness can help avoid this life time disease. Treatment facilities are limited due to the high cost of medicine and limited availability of blood for transfusion. The government of Bangladesh has taken note of the magnitude of the problem and is creating awareness about the disease, which is a very commendable step. It is very important that besides creating awareness about the disease and carrier detection, the government must also simultaneously make facilities available for prenatal diagnosis.

The rapidly-growing number of children diagnosed with thalassemia in Bangladesh clearly indicates that it will be an emerging health problem in our country. So, we need to prevent thalassemia before it is too late under comprehensive and integrated prevention programmes which will include public awareness and education, carrier screening, genetic counseling, premarital screening and prenatal diagnosis. So, ethical issues need to be addressed in the government policy. There should be central control and coordination as per the local structures, social values, cultural tradition and religious laws of the country. The government should engage many more organisations to tackle the menace.

The writer is Consulting Nutritionist and Assistant Creative Director at Protishabda Communications

Email: [email protected]