What dietary and supplement recommendations are suggested for individuals with Glucose-6-phosphate dehydrogenase (G6PD) deficiency?

Dietary and Supplement Recommendations for G6PD Deficiency

Individuals with G6PD deficiency should strictly avoid fava beans and certain medications, while most standard foods and dietary supplements at recommended daily allowances are generally safe.

Foods to Avoid

• Fava beans (broad beans): The only food with conclusive clinical evidence linking it to hemolytic anemia in G6PD deficient individuals 1
• Henna: Evidence links henna to hemolytic reactions in G6PD deficient individuals 2

Safe Foods and Dietary Patterns

• Regular balanced diet: Most common foods are safe for consumption
• Standard multivitamin and mineral supplements: Generally safe when taken at recommended daily allowances 3

Supplement Recommendations

Safe Supplements

• Vitamin C: No evidence of harm at therapeutic doses 2
• Vitamin E: No evidence of harm at therapeutic doses 2
• Vitamin K: No evidence of harm at therapeutic doses 2
• Alpha-lipoic acid (ALA):
  • Safe at therapeutic doses 2
  • May actually enhance antioxidant status in G6PD deficient individuals 4
  • Supplementation with 600 mg/day for 4 weeks has been shown to increase total antioxidant capacity and bilirubin concentrations 4
• Ginkgo biloba: No evidence of harm at therapeutic doses 2

Supplements to Avoid

• High-dose vitamin infusions: Case reports of severe hemolysis following naturopathic vitamin infusions 5
• Avoid any supplements containing oxidative compounds

Medication Precautions

Absolutely Contraindicated Medications

• Methylene blue: Contraindicated due to risk of severe hemolytic anemia and paradoxical worsening of methemoglobinemia 3
• Dapsone: Can cause significant hemolysis 3, 6
• Primaquine: Should be avoided 6
• Nitrofurantoin: Should be avoided 6
• Phenazopyridine: Should be avoided 6
• Rasburicase: Should be avoided 6
• Tolonium chloride (toluidine blue): Should be avoided 6

Special Considerations

For Methemoglobinemia Management

If a G6PD deficient individual develops methemoglobinemia:

1. Do NOT use methylene blue (absolutely contraindicated)
2. Use ascorbic acid (vitamin C) as the treatment of choice:
   • Adults: 0.5-1g every 12 hours, 1.5-2g IV, 5g every 6 hours, or 10g as a single dose
   • Children: 0.5g every 12 hours or 1g every 4 hours 3
3. Consider N-acetylcysteine as adjunctive therapy 3
4. Exchange transfusion for severe cases (81.6% survival rate in refractory cases) 3
5. Hyperbaric oxygen therapy may be considered as an alternative treatment 3

Monitoring Recommendations

• Regular screening for G6PD deficiency should include a thorough history of prior drug-induced hemolytic anemia and ethnic background 3
• Patients should be monitored for signs of hemolysis after starting new medications or supplements
• Watch for symptoms like fatigue, jaundice, dark urine, or abdominal/back pain

Common Misconceptions

• Many compounds have been wrongly cited as causing hemolysis because they were administered during infection-related hemolytic episodes 6
• Food additives, at their permitted level of use in North America, can be consumed safely by most patients with G6PD deficiency 1

By following these dietary and supplement recommendations, individuals with G6PD deficiency can minimize their risk of hemolytic episodes while maintaining adequate nutrition.