Hi doctor, My brother is a thalassemia major subject. His age is 18 years and height is 5'4''. His hemoglobin is always maintained between 9 and 10 units. His weight is 38 now and drastically reducing. Nowadays he has been having headache and fever now and then. Sometimes he feels that his heartbeat is fast. He is taking Desirox 500 mg (three tablets per day) for iron chelation process and folic acid (one tablet per day). Kindly suggest if he needs to take any other precaution. Can you please provide a diet chart for a thalassemia patient which can help him to gain his body mass/weight (considering food with less iron amount)?
Hi. Based on your query regarding thalassemia, my opinion is as follows:1. Looking at a regular hemoglobin level of 9-10%, I would suggest you increase the levels. Maintaining at this level increases further erythropoiesis (production of red blood cells). Close to 12-13 g% maintenance would be much better. Reduced hemoglobin, will reduce oxygen, which will impact overall body (weight loss) and could be the cause of headache at present. Immunity is also reduced, which is resulting in frequent infections. 2. The antibodies may be increased in the blood, which could be more due to multiple transfusions. This could be causing a reduced increase in hemoglobin levels per transfusion leading on to iron overload. You need to look for regular blood donation from a small group (committed donors or donor adaption, 5-6 donors per case) to avoid any further antibodies risk. 3. Iron chelation should be regularly done to maintain iron within normal levels. It should be done regularly. If possible, hepatic iron through liver biopsy estimation can be done. 4. Heartbeats at a faster rate due to reduced hemoglobin and increased oxygen requirement (reduced hemoglobin means reduced oxygen carrying capacity). All the cells in the body have reduced oxygen, which is functioning below the capacity, which will affect weight. Recurrent infections will also impact weight. 5. Tea with meals will reduce the absorption of food. Meat intake should be reduced. Plant-source protein would be better. Avoid any vitamin C rich food in the diet like orange or lime juice. If needed can be taken separately after 2-3 hours of food intake. Adding vitamin E supplements will be helpful. Moderate weight gaining exercises with cycling, swimming, water aerobics will be helpful. 6. Diet rich in fruit and vegetables is better for overall nutrition. Avoid food like oysters, liver, pork, beans, beef, peanut butter, tofu or other nonvegan food. Also avoid iron-fortified cereals, wheat, ragi and among fruits and vegetables, avoid prune juice, prunes, watermelon, spinach, leafy green vegetables, dates, raisins, broccoli, peas, and fava bean. Also, look for iron in snacks, candies, etc. Try to maintain intake of iron from overall diet to less than 18 mg per day. 7. As I told earlier, it is important to take more of foods which decrease iron absorption and reduce foods which increase iron absorption. For your diet, I would recommend cereals, particularly rice, oats or maize along with tea (2 cups). You can vary the diet based on taste. Vitamin C food can be taken 3-4 hours after food intake. Try to improve hemoglobin through effective transfusions, choosing a small group of regular donors is essential. If transfusions are more, particularly in the last year, splenectomy may be necessary. Try to maintain pre-transfusion of 10 - 10.5g% and post-transfusion of 13-14g%, which would help in overall improvement. Iron chelation is very important. Liver biopsy for iron and regular serum iron levels. Hypoxia (oxygen deficiency), reduced hemoglobin levels. Small group donors for transfusion, maintaining hemoglobin at 12-13g%, modified diet with tea, addition of vitamin E supplements, regular exercises. Zinc rich diet would be better. Avoid iron rich foods.