A possible complication of thalassaemia is the development of Diabetes. This could be due to the repeated blood transfusions which puts strain on the pancreas and in turns effects insulin secretion. Iron overload may also be a factor as it can destroy pancreatic beta cells which produce insulin. However, due to the epidemic of diabetes, the development of diabetes could occur independently of thalassaemia.

What is diabetes?

It is a condition where your blood glucose levels are too high. There are different forms of diabetes; there is type 1 diabetes and type 2 diabetes. Type 1 diabetes means that you cannot make insulin at all whereas type 2 diabetes means that you can produce insulin but it either does not work effectively or you cannot produce enough of it.

Is there a cure? Can you reverse diabetes?

There is currently no cure for diabetes, but research is being carried out for type 1 and type 2 diabetes. Type 1 diabetes is where your immune system attacks insulin-producing cells (beta-cells), therefore immunotherapies are currently being developed to stop the immune system from destroying the beta cells. Research into type 2 diabetes and weight management is also being carried out to put diabetes into remission. This means that although the diabetes will not have gone completely, it will help to put blood sugar levels back within the normal range. There is strong evidence that losing weight if you are overweight, can help put your diabetes into remission.

Diabetes and food

There is no specific diet for diabetes. It is important to note that all cases of diabetes are individual, so there is not a one size fits all approach of eating for people with diabetes.

Type 1 diabetes:

Eating a healthy balanced diet is recommended for people with type 1 diabetes. This means that you should eat from all the food groups including:

• • Carbohydrates e.g. pasta, bread, potatoes
  • Protein e.g. chicken, beef, salmon
  • Fat e.g. eggs, avocado, nuts
  • Fruit and vegetables
  • Dairy and alternatives e.g. milk, cheese, un-sweetened yogurts

It is recommended to regulate carbohydrates and have some carbohydrates with each meal to ensure your blood glucose levels remain steady. There is no current research has found that low carbohydrate diets are beneficial or safe for people with type 1 diabetes. It is also recommended to avoid sugary drinks such as fruit juices as they can increase your blood glucose quickly. Instead, try to drink water, sugar-free and diet soft drinks.

Type 2 diabetes:

The advice for those with type 2 diabetes is to make healthier choices and have treats occasionally in small portions.

• • Moderate fat intake is recommended
  • Diets rich carbohydrates that have a low glycaemic index which include soy products, beans, fruit, milk, pasta, grainy bread, porridge (oats) and lentils.
  • Replace butters with margarines and limit use of coconut oil

If you are overweight, loosing weight can be beneficial in managing you blood glucose levels, blood pressure can cholesterol. There is also strong evidence that losing weight can help to put your diabetes into remission. Remission is when your HbA1c — a measure of long-term blood glucose levels — remains below 48mmol/mol or 6.5% for at least six months. 

Maintaining a healthy lifestyle will help to manage your weight by eating healthily and exercising. You can ask your GP to refer you to a dietician who can make specific meal plans for you to help you stick to your diet.

It is important to remember that the diet for both type 1 and type 2 diabetes must be in line with the other requirements specific for those with Thalassaemia for instance, low-iron diet.

Please note that this is general nutrition advice, and everyone has specific needs. For advice that is tailored to you, I would suggest asking your GP to refer you to a dietician.

Sources:

https://www.researchgate.net/publication/273336750_Diabetes_and_thalassaemia

https://www.diabetes.org.uk/

HOW DO I KNOW HOW MUCH IRON IS IN FOODS?

Check food labels as they might state that the food product/ingredients are high in iron. The nutritional information does not usually tell you how much iron is in the product/ food, but you can use the app ‘MyFitnessPal’ to scan the food and it will break down the nutritional value of the food for you of google it.

Keep the iron under 10 mg/day for children under 10 years old, and under 18 mg/day for those who are 11 years old and older.

SUMMARY:

• Dietary iron should be monitored by all patients
• Drinking tea with meals helps to reduce iron absorption
• Check labels and nutritional content of foods before consumption

 

IRON SUPPLEMENTS SHOULD NOT BE TAKEN BY ANYONE WITH THALASSAEMIA!

 

CALCIUM

HOW DOES CALCIUM HELP?

Foods high in calcium should be incorporated in the diet as it is important for bone development and management. It strengthens bones by aiding its structure and rigidity and enables bones to store minerals for the body to use which is particularly important for children and their development. Calcium also reduces haem iron absorption and it can be useful to try to have a glass of milk with meals or incorporate milk into cooking.

Osteoporosis can be an issue some people with Thalassaemia therefore calcium is a crucial component in the diet to strengthens bones and improve bone health. Vitamin D works alongside calcium to ensure calcium is absorbed by the body and is essential for efficient calcium utilisation by the body, therefore it is recommended to take supplements. For those that are lactose intolerant, there are lots of lactose free options that are still high in calcium.

FOOD SOURCES OF CALCIUM?

Foods high in calcium: Milk, cheese and other dairy products provide about half of the calcium in the UK diet. Bread is also an important source in the UK because most bread flour (though not whole meal) is fortified with calcium by law. Calcium is also provided by some green leafy vegetables such as broccoli and cabbage (but not spinach but these should be minimized as they are high in iron), fortified soya products and fish eaten with the bones such as sardines, salmon and whitebait. If you are lactose intolerant, lactose free foods are still high in calcium.

ZINC

WHY IS ZINC IMPORTANT FOR PEOPLE WITH THALASSAEMIA?

Zinc, unlike iron, is not stored in the body, therefore it must be consumed as part of the diet. It is essential for optimal immune function, optimal growth, bone health / bone density, pubertal development and glucose homeostasis which is useful for those with diabetes. From research, it is found that a lot of people with Thalassaemia are deficient in Zinc and it is particularly important in patients receiving transfusions; a Zinc supplement is an option, however, please consult with your GP before intake as Zinc can affect the absorption of other nutrients.

FOODS SOURCES OF ZINC?

Foods that are high in zinc: Mainly found in meat and present in milk, cheese, eggs, shellfish, wholegrain cereals, nuts and pulses. For cereals and pulses, zinc’s availability is limited by phytates. Phytate (in cereals and pulses), fibre, tannins (in tea) and calcium can all bind to non-haem iron in the intestine, which reduces iron absorption.

The following table can give you can idea of the foods that have more and less Zinc.

VITAMINS

VITAMIN E

Paradoxically, oxygen is essential for life but is also lethal! This is because normal oxygen molecules can convert into different chemical forms known as ‘free radicals. When the activity of free radicals is harnessed and controlled, they have important uses in the body. Uncontrolled free radical reactions, however, can do great damage and lead to disease.

Antioxidants are important in any diet, because as their name suggests, they prevent oxidative damage in the body. In doing so, they play an important role in the prevention of diseases such as coronary heart disease and cancer. In Thalassaemia, because of the excess iron in the body, there is a higher risk of oxidative damage.

Vitamin E is an important antioxidant and has a role in immune function.

SOURCES OF VITAMIN E

Vitamin E is mainly found in vegetable oils such as olive oil and safflower oil. The best one to use is probably olive oil because it can help to protect against heart disease. Add it towards the end of cooking, after the food is cooked or on raw vegetables because heating can destroy the vitamin.

The following table can give you can idea of the foods that have more and less Vitamin E.

What should be eaten less often for thalassaemia patients?

WHAT SUPPLEMENTS SHOULD I TAKE?

*Ensure to check with your GP before intake*

• • Folic acid: is recommended for thalassaemia intermediate patients this will help with anaemia and it is also important for women to supplement folic acid to prevent developmental abnormalities of babies in the womb.
  • Vitamin D: Vitamin D is mainly absorbed from the sun, so since the UK weather is not as sunny and holidays are unlikely this year, it is recommended for all to take a vitamin D supplement. Vitamin D is also essential for calcium absorption which is vital for bone health and strength
  • Multivitamin is suggested (without iron is suggested)

HOWEVER, I cannot stress this enough, this is so important to get your vitamins and minerals through food itself first and use supplements if you are struggling to meet the recommended intake as suggested by your haematology team.

HEALTHY FOOD SWAPS

Changing habits such as the foods you normally eat can be difficult. However, by making small changes and replacing some of the foods you normally eat with the foods that are recommended, it can make a big difference.

EASY TIPS TO INCORPORATE INTO YOUR DAILY ROUTINE

• • Drink tea between meals rather than with your meals especially after foods that are high in iron and vitamin C (coffee should be limited to one a day as the caffeine can thin bones as it interferes with calcium absorption)
  • Add milk or dairy products into your meals e.g. lasagne, moussaka
  • If you can sit in the sun for around 20 minutes, this will help your Vitamin D intakes as the sun is the main source.

Check out our recipes for more ideas!

Season your food with turmeric. Turmeric is an antioxidant that has anti-inflammatory properties and is a great addition to meals as it is delicious too! Curcumin, which is the active polyphenol in turmeric, has been found to significantly reduce serum levels of non-transferrin bound iron, therefore curcumin has a beneficial effect on reducing excess iron¹. A study showed that at equivalent concentrations of desferrioxamine, deferiprone, and curcumin, none of these chelators completely removed NTBI, but curcumin increased the rate of NTBI removal when added to deferiprone². It is important to note that curcumin supplements are not a treatment for iron overload, and it is vital to continue to use your iron chelation medicine. Curcumin supplements should be discussed with your haematology team before consumption.

Please note that this is generic nutritional advice, and everyone has their own nutritional needs that is specific to them. For nutritional advice that is tailored to you, I would suggest seeing a registered dietician.

References:

1. 1. Mohammadi, E., Tamaddoni, A., Qujeq, D., Nasseri, E., Zayeri, F., Zand, H., Gholami, M. and Mir, S.M., 2018. An investigation of the effects of curcumin on iron overload, hepcidin level, and liver function in β‐thalassemia major patients: A double‐blind randomized controlled clinical trial. Phytotherapy Research, 32(9), pp.1828-1835.
   2. Srichairatanakool, S., Thephinlap, C., Phisalaphong, C., Porter, J.B. and Fucharoen, S., 2007. Curcumin contributes to in vitro removal of non-transferrin bound iron by deferiprone and desferrioxamine in thalassemic plasma. Medicinal chemistry, 3(5), pp.469-474.
   3. Zijp, I.M., Korver, O. and Tijburg, L.B., 2000. Effect of tea and other dietary factors on iron absorption. Critical reviews in food science and nutrition, 40(5), pp.371-398.
   4. Swe, K.M.M., Abas, A.B., Bhardwaj, A., Barua, A. and Nair, N.S., 2013. Zinc supplements for treating thalassaemia and sickle cell disease. Cochrane Database of Systematic Reviews, (6).
   5. Thalassemia Standard of Care Guidelines: Nutrition – Thalassemia.com
   6. Living with Thalassemia: Nutrition and Diet – Thalassemia.com
   7. Goldberg, E.K., Neogi, S., Lal, A., Higa, A. and Fung, E., 2018. Nutritional deficiencies are common in patients with transfusion-dependent thalassemia and associated with iron overload. Journal of food and nutrition research (Newark, Del.), 6(10), p.674.
   8. Fuchs, G.J., Tienboon, P., Linpisarn, S., Nimsakul, S., Leelapat, P., Tovanabutra, S., Tubtong, V., DeWier, M. and Suskind, R.M., 1996. Nutritional factors and thalassaemia major. Archives of disease in childhood, 74(3), pp.224-227.