Iron is a mineral that is commonly deficient among Filipinos, especially in children and pregnant women. Deficiency of this nutrient leads to iron deficiency anemia. This is characterized by fatigue or lack of energy, shortness of breath, weakness, rapid heartbeat, paleness, headache, pounding in the ears, and craving for ice, which is also known as picophagia. These symptoms are experienced as a result of low hemoglobin, the blood component that carries oxygen all over the body.
While having iron deficiency anemia is common, the opposite can also occur. Having too much iron or hemochromatosis can damage organs like the liver, heart, and pancreas, where iron can be stored, possibly resulting in liver failure, heart diseases, or diabetes.
Iron overload occurs in individuals with an inherited blood disorder called thalassemia. The deleted genes cause the body to produce less of the protein hemoglobin and fewer red blood cells leading to anemia. Unlike iron deficiency anemia, however, people with thalassemia must never be treated with iron supplementation. Otherwise, it will increase the serum ferritin level or iron stores, which could lead to iron overload. Patients with thalassemia have increased absorption of iron due to the bone marrow’s inability to produce red blood cells efficiently from iron, thus the excess. Blood transfusion among patients with thalassemia can also cause iron overload.
Thalassemia has four classifications, depending on the severity of symptoms: trait, minor, intermedia, and major. Symptoms may range from none to severe. There are two types of thalassemia, depending on the genetic defect: alpha thalassemia and beta thalassemia. Alpha thalassemia is common among Africans, Southeast Asians, Southern Chinese, Middle Easterns, and those from the Mediterranean race.
Since iron level is crucial in thalassemia and supplementation of this mineral is not done to correct anemia, how can we make healthy red blood cells? We need vitamin B12, folate, and protein from plant and animal sources. It is also important to get adequate rest and sleep.
It is recommended to avoid iron rich food sources. Most health professionals would tell patients to avoid dark green and leafy vegetables, which are rich sources of folate and not just iron. Can a person with thalassemia still eat broccoli? As a registered nutritionist dietitian and whole food, plant-based advocate, I say definitely!
The Northern California Comprehensive Thalassemia Center at UCSF Benioff Children’s Hospital Oakland recommends to keep iron intake to 10mg/day for children under 10 years old and less than 18mg/day for 11 years and older. Therefore, you can eat your green leafy vegetables like malunggay as long as you stay within the recommended daily iron intake. It is important to take note that while these vegetables are rich in iron, broccoli and most leafy greens only contain less than 1mg of iron per cup as compared to more than double the amount of iron in palm-sized red meat (pork, beef), including liver and other organ meats.
Shouldn’t we be avoiding red meat instead of the vegetables? Animal meat has heme iron that is readily absorbable, whereas plants have non-heme iron that requires vitamin C to be absorbed.
If you wish to decrease the absorption of non heme iron from plant sources, do not eat tofu, beans, prunes, watermelon, spinach, green leafy vegetables, dates, raisins, broccoli, and peas together with vitamin C-rich food like citrus fruits, guava, tomatoes, berries, kiwi, bell peppers, and other cruciferous vegetables like cabbage and cauliflower. You can have the vitamin C-rich fruits for a snack instead.
In addition, drinking tea from camellia sinensis (green, black, white, and oolong) during meal times will further decrease iron absorption. The phytochemical tannin in tea binds with iron and interferes with its absorption.
In 2018, Amit S. Mutha and colleagues studied the efficacy and safety of wheatgrass in thalassemic children on regular blood transfusion. Their study concluded that wheatgrass appears to play a promising role among children with thalassemia receiving chronic blood transfusions.
The results of the study showed significant difference in spleen and liver sizes as well as quality of life in the group taking wheatgrass. Folic acid in wheatgrass plays an important role in biochemical reactions benefitting thalassemia patients. Wheatgrass also contains the green pigment chlorophyll that is readily absorbed and used by the bone marrow to produce healthy red blood cells. It also has methyl pheophorbide, an antioxidant that helps with iron overload.
If you have thalassemia, it is best to only consult a registered nutritionist dietitian regarding food synergy and what food you can safely consume to keep your ferritin level within normal range and prevent complications.
There is hope to live a long quality life for people with thalassemia.