Can you please provide a diet chart for a thalassemia patient?

Hi,

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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 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 the overall body (weight loss) and could be the cause of headaches 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 to iron overload. You need to look for regular blood donation from a small group (committed donors or donor adaptation, 5-6 donors per case) to avoid any further antibody risk.

3. Iron chelation should be regularly done to maintain iron levels within normal. 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 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, such as 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, and water aerobics will be helpful.

6. A diet rich in fruit and vegetables is better for overall nutrition. Avoid food like oysters, liver, pork, beans, beef, peanut butter, tofu, or other non-vegan 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 beans. Also, look for iron in snacks, candies, etc. Try to maintain intake of iron from the overall diet to less than 18 mg per day.

7. As I told earlier, it is important to take more foods that decrease iron absorption and reduce foods that increase iron absorption.

• Cereals like wheat bran, maize, oats, rice, and soy. Soy protein can be added in diet during muscle building exercises. It is important to avoid any vitamin C food along with this.
• Tea particularly and coffee also will reduce iron absorption. Taking meals with tea and coffee, particularly with milk will reduce iron absorption. You can add spices like oregano to the diet.
• Take more dairy products like milk, cheese, and yogurt which reduce iron absorption, particularly with meals. Make sure, all are non-iron fortified.
• Also avoid pickles, vinegar fermented food, alcohol, soy sauce, turnips, and carrots. Alcohol consumption and smoking should be avoided.
• 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.