How Diet Can Help Support Sickle Cell Patients: A Nutritionist’s View
Strong evidence points to some complications of sickle cell anemia (SCA) having as much to do with nutrition as they do with genes. Characteristics and symptoms of the disease include poor growth, pain, infection, decreased muscle function, problems with cognition and coordination, low antioxidant status, and anemia.
Hypermetabolism — increased metabolic rate and nutrient need — a low nutrient intake secondary to inflammatory cytokines, and potentially inadequate nutrition due to socioeconomic status are among the leading suppositions supporting this hypothesis.
A case for hypermetabolism, and subsequent problems with nutrition, was detailed in a study published in 2013 in the Journal of Health and Social Nutrition. “The patient with SCA is in a state where catabolism exceeds anabolism, resulting in an energy requirement that exceeds the apparently adequate nutrient intake in the absence of SCA. This hypermetabolism has been documented as increased REE [Resting Energy Expenditure], which is a measure of the energy consumption of an individual at rest. Studies show that individuals with SCA have a higher REE compared with age- and sex-matched healthy controls,” its researchers wrote.
The article goes on to report, “This hypothesis thus posits that hypermetabolism leads to undernutrition because it causes a diversion of nutrients from growth and other required body functions to support the increased requirement for red cell production, increased myocardial energy demand due to increased heart rate (a compensatory mechanism for anemia), and propagation of the state of chronic subclinical inflammation reported among SCA patients.”
Reducing recurrent painful episodes and hospital visits has been the primary focus in clinical care of SCA.
In the late 1980s, undernutrition as a precursor to proper maturation, growth, and immunity came to light. Since, it has been a struggle to get the clinical community to understand how a combination of macro- and micronutrient supplements can be used to improve quality of life.
SCA treatments such as hydroxyurea and oral antibiotics are beneficial; however, they come with side effects such as alloimmunization and iron overload. The study mentioned earlier concludes that “these approaches alone are unable to promote growth and maturity to any appreciable level. It is the position of the authors, however, that if these interventions were coupled with additional caloric supplementation, the results might be different.”
A nutritional intervention to consider is a high protein diet (about 35% total energy intake) that can lessen the likelihood of infection. We have seen this specifically with diets rich in the amino acid arginine.
Argenine’s benefits for SCA patients come via its metabolite nitric oxide, which works to reduce pain and vaso-occlusive crisis (VOC) and increase muscle function, according to a 2016 study in the journal Nutrition & Metabolism. “VOC plays an important role in both vascular vasodilation allowing blood to flow easily, and in reducing the adhesiveness of sickled erythrocytes to the vascular wall. It also reduces platelet aggregation and protects the blood vessels from free radicals,” its scientists wrote.
Additional micronutrient supplements of note include zinc for improved growth and immunity, chromium for carbohydrate metabolism and energy, manganese and vitamin D for bone health as well as energy, magnesium for cellular hydration balance, and the B vitamins for their crucial roles as enzyme co-factors, neuro-transmitter precursors, and amino acid metabolism.
Levels of antioxidants are compromised in sickle cell patients, leading to inflammation and pain. Plant compounds called flavonoids are beneficial here, as are the natural antioxidants vitamin A, C and E. “It appears that antioxidant vitamins may work better as a cocktail than individually for improving clinical status in SCA patients,” reports a 2010 review article in Nutrition & Metabolic Insights.
Lean body mass is typically an indicator of REE and energy/protein needs in healthy individuals. Due to hypermetabolism, sickle cell patients consistently have higher-than-normal REE and lower-than-normal lean body mass, and this deficiency is now more clearly defined as a complication of SCA.
New dietary recommendations (recommended dietary allowances) will need to be determined for this patient population to arrive at a proper combination of macro- and micronutrient dense diets.
These diets, in combination with treatment, can help people with sickle cell achieve optimal nutrition and immune status, ultimately reducing morbidity and mortality by supporting a satisfactory level of nutritional and immune health.