Have you been searching the Internet for the essential vitamins and minerals you need to maintain your health and lower your risk of developing another sickle crisis?

Look no further. I’ve got you!

The five essential vitamins and minerals people with sickle cell anaemia need include vitamin A, vitamin D, magnesium, selenium, and zinc. And while they’re not a vitamin or mineral, omega-3 fats are also crucial. 

Don’t rush to buy supplements just yet; most of these nutrients are abundant in food. Besides, many over-the-counter supplements contain iron, which may be detrimental for you. 

I’ll share the best dietary sources of these nutrients. And if you wish to take supplements (after consulting with your doctor and healthcare team), I’ll also share the most bioavailable formulations on the market. 

Before we jump in, let’s cover some basics. 

Why you need more nutrients

The average lifespan of red blood cells in a person without sickle cell is 100–120 days, but your red blood cells have a lifespan of only 10-20 days (Ilesanmi, 2010). 

Consequently, your bone marrow makes red blood cells faster than a healthy person, and because your bone marrow can’t keep up with the rate of your red cell destruction, you develop anaemia. 

Red blood cell production requires ample energy, protein, vitamins and minerals, especially vitamin B12, iron and folate (Koury and Ponka, 2004). 

Without sufficient energy and nutrients, you’re likely to become malnourished, develop frequent infections, and suffer severe sickle crisis. 

Many people are unaware that government dietary recommendations are for healthy people (Herforth et al., 2019). People who are ill, malnourished or live with chronic conditions may have greater energy and micronutrient needs. But regulatory bodies haven’t developed dietary requirements for people in these categories  

The little research available shows that people with sickle cell need higher quantities of vitamin A, vitamin D, calcium, magnesium, selenium, zinc and omega-3 fats. 

Let’s explore these nutrients in detail and discover why you must increase your intake.

Vitamin A

Vitamin A, a fat-soluble vitamin, is vital for growth, vision and immunity (Huang et al., 2018).

Low vitamin A levels impair your body’s ability to fight infections – your antibodies can’t destroy infectious agents, and T-cells (another type of immune cell) can’t migrate into your gut to fight infections. Unfortunately, most infectious agents enter your bloodstream through your gut. 

Vitamin A deficiency also promotes inflammation, encouraging your body to produce more inflammatory proteins and fewer anti-inflammatory proteins.

Up to 66% of people with sickle cell anaemia have deficiencies or suboptimal levels of vitamin A, predisposing them to even lower haemoglobin levels, a high risk of severe pain and fever episodes, and a 10-fold increase in hospitalisations from sickling crisis (Behera et al., 2012; Kuvibidila et al., 2018; Schall et al., 2004).

Do vitamin A supplements correct the deficiency?

Well, researchers recently investigated the effects of high-dose (900-1800µg) vitamin A supplements in children with sickle cell anaemia. Supplements didn’t correct their vitamin A levels, but they improved their growth, muscle strength and red cell blood function (Brownell et al., 2020). 

And just in case you wondered, twelve months of low-dose (300-600µg) vitamin A supplements didn’t improve vitamin A status in children either. (Dougherty et al., 2012). 

Even though research doesn’t support supplement use, you can improve your vitamin A intake by eating vitamin A-rich foods. Your body uses nutrients more efficiently from natural food than it does supplements. And natural food contains many other beneficial nutrients that work together to maintain health (Jacobs and Tapsell, 2013). 

Excellent dietary sources of beta-carotene (converted to vitamin A in the body) and vitamin A include (Gilbert, 2013):

• Liver
• Egg yolk
• Dairy (milk, cheese and butter)
• Spinach
• Carrots 
• Orange sweet potatoes
• Pumpkin
• Yellow maise
• Mangoes
• Red palm oil 

Frying palm oil to bleach it, overcooking vegetables and drying fruits directly in sunlight destroys vitamin A (Gilbert, 2013). Instead, always eat vegetable sources of vitamin A with fat, e.g., avocado, coconut, olive or palm oil, to improve your body’s ability to absorb its vitamin A. 

Selenium

Selenium is a trace element with antioxidant properties that protects you from harmful free radicals (Kieliszek, 2019). It maintains thyroid health, boosts immunity, and slows ageing. Selenium is also a component of many crucial enzymes in your body (Kieliszek, 2019). 

Selenium deficiencies lower immunity, impair the cardiovascular and nervous systems and cause hair loss, skin and nail lesions (Shahid et al., 2018; Steinbrenner et al., 2013; Aldosary et al., 2012). It can also cause depression, anxiety or Alzheimer’s disease. 

Up to 93.5% of people with sickle cell anaemia are selenium deficient, which correlates with a higher rate of red blood cell destruction, low haemoglobin levels, oxidative stress and low red cell counts (Delesderrier et al., 2019). 

Selenium deficiency may increase the risk of pain and severe sickle crisis (Hong et al., 2019; Jagadeeswaran et al., 2018). 

To our knowledge, no study has investigated the effect of selenium supplements on the severity of sickle cell anaemia. But since we know that most people with sickle cell anaemia are selenium deficient, it may be worth increasing your selenium intake. 

Dietary sources of selenium include:

• Brazil nuts
• Liver
• Fish
• Eggs
• Chicken
• Beef
• Pork
• Broccoli

Your body absorbs selenium best when vitamins A, C, E and proteins containing methionine are present (Kieliszek, 2019). Examples of methionine-containing proteins are eggs, fish, sesame seeds, and brazil nuts. 

Zinc

Zinc is an essential mineral for human health. It is a component of many enzymes – proteins required for chemical reactions in the body–, it helps with protein folding and controls gene activation (Saper and Rash, 2009). 

Zinc deficiency causes diarrhoea, hair loss, impaired growth, decreased immunity, delayed puberty, and erectile dysfunction (Roohani et al., 2013).

Zinc deficiency is common in people with sickle cell anaemia, affecting up to 70% of adults with the condition (Prasad et al.,1999). When your red blood cells break down, which happens constantly, they release zinc into your bloodstream. Zinc in your bloodstream is transported to the kidneys, which usually reabsorbs (soaks it up) it. However, constant pain crisis damages kidneys cells and makes them inefficient at reabsorbing zinc. Consequently, zinc is excreted in the urine, causing deficiencies (Prasad et al., 1999). 

People with sickle cell anaemia don’t get enough zinc via diet, so supplements may be necessary to avoid deficiency and its side effects (Prasad et al., 1999).

Do zinc supplements correct the deficiency?

Zinc-deficient adults with sickle cell anaemia were treated with 50-75 mg of zinc acetate for up to three years in a study. Zinc levels normalised, and infection rates, the number of crises and hospital visits decreased considerably (Prasad et al., 1999). Another three-month study confirmed that zinc supplements (75mg daily) reduce infection rates and decreases inflammatory protein levels in people with sickle cell (Bao et al., 2008). 

Check with your physician or healthcare team before taking supplements. If you are cleared to take a supplement, choose zinc acetate, zinc gluconate or zinc citrate supplements. 

While supplements may be necessary, dietary zinc sources are also important. As mentioned earlier, they provide other beneficial nutrients for health. Excellent dietary zinc sources include:

• Oysters
• Seafood
• Red meat
• Poultry
• Cheese
• Liver
• Pumpkin seeds
• Oats

Your body absorbs zinc more efficiently from animal protein sources than it does from plant foods (Roohani et al., 2013). This is because plant foods are rich in compounds called phytates that prevent your body from absorbing sufficient zinc (Roohani et al., 2013).

Magnesium

Magnesium is essential for muscle and nerve function, blood glucose control, blood pressure regulation, energy production and heart function (Alawi et al., 2018). 

Magnesium deficiency can cause weak bones, muscle spasms, respiratory diseases and brain disorders, including stress, depression, and anxiety (Razzaque, 2018). 

Pain in sickle cell arises because red blood cells stick to blood vessels and block them, stopping proper blood flow. Magnesium widens blood vessels, and when regularly given to patients, it hydrates red blood cells and prevents sickling (Than et al., 2017). 

However, magnesium supplementation –whether orally or through the vein– hasn’t reduced the frequency of sickle crises, the dose of pain medication, and the length of hospital stays in clinical trials (Goldman et al., 2013; Than et al., 2017). So, it may be unnecessary to take magnesium supplements.

Good dietary sources of magnesium include:

• Almonds
• Bananas
• Black beans
• Broccoli
• Brown rice
• Cashews
• Flaxseeds
• Spinach
• Pumpkin seeds
• Soybeans
• Sweet corn
• Whole grains (brown rice, wheatberries, pearl barley)

Vitamin D

Vitamin D, a fat-soluble vitamin, is essential for healthy bones and teeth (Basit, 2013). It maintains blood calcium and phosphorus levels, regulates blood sugar, improves immunity, and maintains brain health (Nair and Maseeh, 2012). 

Vitamin D deficiency (VDD) is a global health problem, affecting approximately 40% of Europeans (Amrein et al., 2020).  VDD increases the risk of respiratory infections, asthma, tuberculosis rickets in children and osteomalacia (weak bones) in adults (Roth et al., 2018). Breastfed infants, older adults, people with dark skin or those who cannot absorb fat properly are most at risk of VDD (Nair and Maseeh, 2012). 

The rates of VDD in sickle cell disease are alarming, reaching 96% in some populations (AlJama et al., 2018). In a recent study of adolescent patients with sickle cell, normalising vitamin D levels with supplements reduced the number of crisis-related hospital visits (Hood et al., 2020). 

A new clinical trial (NCT04662476) to investigate the effect of vitamin D supplementation on hospitals in Ugandan children aged six months to 12 years with sickle cell has recently been registered on ClinicalTrials.gov.

The recommended vitamin D dose for healthy individuals in the UK is 10mcg per day. Since there’s no specific recommendation for patients with sickle cell, the same dose applies. The body readily absorbs vitamin D₃ supplements but needs to convert vitamin D₂ to vitamin D₃ before using it (Lamberg-Allardt, 2006). So, it is best to take vitamin D₃ supplements. 

Also, note that your body absorbs vitamin D₃ from a gummy better than from a tablet or pill (Wagner et al., 2019). 

Sunshine is the best vitamin D source. However, only a limited number of foods naturally contain vitamin D. The best sources include (Lamberg-Allardt, 2006):

• Fatty fish such as salmon, mackerel, trout and sardines
• Fortified dairy and dairy alternative products (e.g., almond milk, soy milk, and tofu)
• Egg yolk 
• Breakfast cereal
• UV-treated mushrooms

Omega-3 fats

Omega-3 fats are classified as essential fats because you can only get them through diet. Your body cannot make them. Omega-3 fats can reduce inflammation and the risk of chronic diseases such as heart disease, cancer, and arthritis. They also regulate blood pressure and promote brain and nerve function (Swanson et al., 2012; Wall et al., 2010). 

Three types of omega-3 fats exist; alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA are found in cold-water fish, while ALA is found in plant foods. Your body needs to convert ALA to EPA and DHA before it can use it. However, conversion rates are abysmal (~2-10%) in most humans (Swanson et al., 2012). 

Our diets, in general, tend to be heavy in omega-6 fatty acids, which are pro-inflammatory and poor in anti-inflammatory omega-3 fats. This is no exception in people with sickle cell. However, people with sickle cell have abnormally high levels of omega-6 fats in their red blood cells, increasing the risk of sickle crises. 

In a 12-month study of young children and adults with sickle cell, EPA+ DHA omega-3 supplements considerably reduced the number of sickle crises, anaemia, and blood transfusions. It also reduced the number of disease-related school and work absences (Daak et al., 2013). 

Good sources of omega-3 fats include:

• Fatty fish such as salmon, mackerel, sardines
• Algae 
• Krill
• Flaxseeds 
• Chia seeds
• Walnuts 
• Soybeans
• Perilla seeds 

Taking many individual supplements can be difficult to maintain consistently. And it is challenging to find supplement formulations with the most bioavailable ingredients that are vegan, sugar and filler-free! I’ve searched for ages, and I’ve finally found a brand that ticks all these boxes and more! 

L-glutamine is another nutrient, albeit an amino acid, with scientifically proven benefits for people with sickle cell (Cox et al., 2020). The supplement brand I recommend contains all the nutrients you need in the most bioavailable format; it also contains L-glutamine!

Go ahead and check out FEEL. I will be upfront and let you know that I’m affiliated with the brand. I rarely recommend supplements, and in fact, I advise people against them except in cases of deficiency. Associating myself with a supplement brand is a big deal for me. So, believe me when I say they’re that good. 

I highly recommend FEEL’s multivitamin supplement. 

You know the five vitamins and minerals essential for sickle cell anaemia

You also know the best dietary sources of each of them and the supplements with the most available ingredients.

You simply need to improve the quality of your diet, and after checking with your doctor, add appropriate supplements, if necessary. 

That said, supplements do not replace a healthy diet.

And remember, sickle cell management is more than medication and transfusions. Diet is KEY!

REFERENCES

1. Koury, M.J., and Ponka, P. (2004) New insights into erythropoiesis: the roles of folate, vitamin B12 and iron. Annual Reviews of Nutrition, 24, 105-31. 
2. Herforth, A., Arimond, M., Alvarez-Sanchez, C., Coates, J., Christianson, K., and Muehlohoff, E (2019) A global review of food-based dietary guidelines. Advances in Nutrition, 10(4), 590-605. 
3. Ilesanmi, O.O (2010) Pathological basis of symptoms and crises in sickle cell disorder: implications for counselling and psychotherapy. Hematology Reports, 2(1), e2
4. Erhabor, O., Ogar, K., Erahbor, T., Dangana, A. (2019) Some haematological parameters, copper and selenium level among children of African descent with sickle cell disease in specialist hospital Sokoto, Nigeria. Human Antibodies, 27(3), 143_154.
5. Sungu, J.K., Mukuku, O., Mutombon, A.M., Mawaw, P., Aloni, M.N., Luboya, O.N. (2017) Trace elements in children suffering from sickle cell anaemia: a case-control study. Journal of Clinical Laboratory Analysis, 32, e22160.
6. Huang, Z., Liu, Y., Qi, G., Brand, D., and Zheng, S.G. (2018) Roel of vitamin A in the immune system. Journal of Clinical Medicine, 7(9), 258. 
7. Behera, S., Dixit, S., Bulliyya, G., Kar, S.K. (2012) Vitamin A status and haematological values in sickle cell disorder cases. Indian Journal of Medical Sciences, 66(7-8), 169-74.
8. Kuvibidila, S.R., Gardner, R., Velez, M., Warrier, R. (2018) Clinical observations, plasma retinol concentrations, and in vitro lymphocyte functions in children with sickle cell disease. The Ochsner Journal, 18(4), 308-317.
9. Schall, J.I., Zemel, B.S., Kawchak, D.A., Ohene-Frempong, K., Stallings, V.A. (2004) Vitamin A status, hospitalisations, and other outcomes in young children with sickle cell disease. The Journal of Pediatrics, 145(1), 99-106. 
10. Dougherty, K.A., Schall, J.I., Kawchak, D.A., Green, M.H., Ohene-Frempong, K., Zemel, B.S., Stallings, V.A. (2012) No improvement in suboptimal vitamin A status with a randomised, double-blind, placebo-controlled trial of vitamin A supplementation in children with sickle cell disease. American Journal of Clinical Nutrition, 94(4), 932-40. 
11. Gilbert, C. (2013) What is vitamin A and why do we need it? Community Eye Health, 26(84), 65.
12. Jacobs, D.R and Tapsell, L.C (2013) Food synergy: the key to a healthy diet. Proceedings of the Nutrition Society, 72(2), 200-206.
13. Lichtenstein, A.H., and Russell, R.M. (2005) Essential nutrients: food or supplements? Where should the emphasis be? American Medical Association, 294(3), 351-357.
14. Kieliszek, M. (2019) Selenium-fascinating, microelement, properties and sources in food. Molecules, 24, 1298. 
15. Shahid, M., Niazi, N.K., Khalid, S., Murtaza, B., Bibi, I., Rashid, M.I. (2018) A critical review of selenium biogeochemical behaviour in soil-plant system with an inference to human health. Environmental Pollution, 234, 915-934. 
16. Steinbrenner, H., Sies, H. (2013) Selenium homeostasis and antioxidant selenoproteins in brain: Implication for disorders in the central nervous system. Archives of Biochemistry and Biophysics, 536, 152-157.
17. Aldosary, B.M., Sutter, M.E., Schwartz, M., Morgan, B.W. (2012) Case series of selenium toxicity from a nutritional supplement. Clinical Toxicology, 50, 57-64.
18. Delesderrier, E., Cople-Rodrigues, C.S., Omena, J., Fleury, M.K., Brito, F.B., Bacelo, A.C., Koury, J.C., and Citelli, M. (2019) Selenium status and hemolysis in sickle cell disease patients. Nutrients, 11, 2211. 
19. Hong, L., Jagadeeswaran, R., Molokie, R., Lavelle, D., Rivers, A., and Diamond, A. (2019) Selenium deficiency in a mouse model of sickle cell disease resulted in increased oxygen consumption and aberrant mitochondrial retention. Current Developments in Nutrition, 3(1). 
20. Jagadeeswaran, R., Lenng, H., Zhang, H., Afranie-Sakyi, J., Molokie, R.E., Lavelle, D., Diamond, A., Rivers, A. (2018) The impact of selenium deficiency on a sickle cell disease mouse model. Blood, 132(Supplement 1), 3545.
21. Saper, R.B., and Rash, R. (2009) Zinc: An essential micronutrient. American Family Physician, 79(9):768.
22. Roohani, N., Hurrell, R., Kelishadi, R., and Schulin, R. (2013) Zinc and its importance for human health: An integrative review. Journal of Research in Medical Sciences, 18(2), 144-157.
23. Prasad, A.S., Beck, F.W.J., Kaplan, J., Chandrasekar, P.H., Ortega, J., Fitzgerald, J.T., and Swerdlow, P. (1999) Effect of zinc supplementation on incidence of infections and hospital admissions in sickle cell disease (SCD). American Journal of Hematology, 61, 194–202. 
24. Bao, B., Prasad, A.S., Beck, F.W.J., Snell, B.D., Suneja, A., Sarkar, F.H., Doshi, N., Fitzgerald, J.T., and Swerdlow, P. (2008) Zinc supplementation decreases oxidative stress, incidence of infection, and generation of inflammatory cytokines in sickle cell disease patients. Translational Research, 152, 67–80.
25. Alawi, A.M., Majoni, S.W., and Falhammar, H. (2018) Magnesium and human health: Perspectives and research directions. International Journal of Endocrinology, 2018,9041694.
26. Razzaque, M.S. (2018) Magnesium: Are we consuming enough? Nutrients, 10(12):1863.
27. Than, N.N., Soe, H.H.K., and De Franceshi, L. (2017) Magnesium for treating sickle cell disease. The Cochrane Database of Systematic Reviews, 2017(4): CD011358.
28. Goldman, R.D., Mounstephen, W., Kirby-Allen, M., and Friedman, J.N. (2013) Intravenous magnesium sulfate for vaso-occlusive episodes in sickle cell disease. American Academy of Pediatrics,132:e1634-e1641. 
29. Basit S (2013) Vitamin D in health and disease: a literature review. British Journal of Biomedical Science, 70(4):161-72.
30. Nair, R and Maseeh, A. (2012) Vitamin D: The “sunshine” vitamin. Journal of Pharmacology and Pharmacotherapeutics, 3(2):118-126. 
31. Amrein, K., Scherkl, M., Hoffmann, M., Neuwersch-Sommeregger, S., Kostenberger, M., Berisha, A.T., Martucci, G., Pilz, S and Malle, O. (2020) Vitamin D deficiency 2.0: an update on the current status worldwide. European Journal of Clinical Nutrition, 74, 1498-1513.
32. AlJama, A., AlKhalifah, M., and Alqudaihi, G. (2018) Vitamin D deficiency in sickle cell disease patients in the Eastern Province of Saudi Arabia. Annals of Saudi Medicine; 38(2): 130-136. 
33. Roth, D.E., Abrams, S.A., Aloia, J., Bergeron, G., Bourassa, M.W., Brown, K.H., Calvo, M.S., Cashman, K.D., Combs, G., De-Regil, L.M., Jefferds, M.E., Jones, K.S., Kpaner, H., Martineau, A.R., Neufeld, L.M., Schleicher, R.L., Thacher, t.D., and Whiting, S.J. (2018) Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low-and middle-income countries. Annals of the New York Academy of Sciences, 1430(1): 44–79.
34. Hood, A.M., Quinn, C.T., King, C.D., Shook, L.M., Peugh, J.L., Crosby, L.E. (2020) Vitamin D supplementation and pain-related emergency department visits in children with sickle cell disease. Complementary Therapies in Medicine, 49, https://doi.org/10.1016/j.ctim.2020.102342.
35. Lamberg-Allardt, C. (2006) Vitamin D in foods and as supplements. Progress in Biophysics and Molecular Biology, 92(1), 33-8. 
36. Wagner, C.L., Shary, J.R., Nietert, P.J., Wahlquist, A.E., Ebeling, M.D., and Hollis, B.W. (2019) Bioequivalence studies of vitamin D gummies and tablets in healthy adults: Results of a cross-over study. Nutrients, 11, 1023; doi:10.3390/nu11051023.
37. Swanson, D., Block, R., Mouser, S.A. (2012) Omega-3 fatty acids EPA and DHA: Health benefits throughout life. Advances in Nutrition, 3(1), 1-7.
38. Wall, R., Ross, R.P., Fitzgerald, G.F., Stanton, C. (2010) Fatty acids from fish: The anti-inflammatory potential of long-chain omega-3 fatty acids. Nutrition Reviews, 68, 280-289.
39. Daak, A.A., Ghebremeskel, K., Hassan, Z., Attallha, B., Azan, H.H., Elbashir, M.I and Crawford, M. (2013) Effect of omega-3 (n-3) fatty acid supplementation in patients with sickle cell anaemia: randomised double-blind, placebo-controlled trial. The American Clinical Journal of Nutrition, 97(1), 37-44.
40. Cox, S.E., Hart, E., Kirkham, F.J., Stotesbury, H. (2020) L-Glutamine in sickle cell disease. Drugs of Today (Barcelona), 56(4), 257-268.