PRELIMINARY REPORT ON THE USE OF NUTRACEUTICALS IN THE MANAGEMENT OF SICKLE CELL ANEMIA: A CASE SERIES

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A.D. Ajibade¹, O.S. Michael²

1. Brain and Body Foundation, Abuja, FCT, Nigeria.
2. Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Nigeria.

Abstract

Background: There is growing recognition of the benefits of nutraceuticals in the management of sickle cell disease but a scarcity of reports on their use. Nutraceuticals are food or parts of food that provide medical or health benefits. They include botanicals, functional foods and medicinal foods. This is a preliminary report on the use of nutraceuticals in the management of a small cohort of children with sickle cell disease in Nigeria.

Patients and Methods: the retrospective audit of clinical outcomes was carried out at a brain center located within the Federal Capital Territory, Abuja, Nigeria. Children, aged 1 to 12 years, presenting with sickle cell anaemia were evaluated at baseline and at six months after the commencement of a cocktail of nutraceuticals using an objective grading tool. Changes in weight, haematocrit and frequency of sickle cell crises were determined. On account of the small sample size, Wilcoxon sign test was used to determine the similarity / difference between the average values of weight, PCV, and crises obtained at enro7lment and six months.

Results: Ten children with sickle cell anaemia were placed on nutraceuticals therapy. The average age of the children was 8.5 (range 1 – 12) years. Aroga immune support was the commonest component of the nutraceutical cocktail given to the children. There was a rise in average weight (from 21.8 to 23.0 Kg, p-value 0.236) and average haematocrit (22.8 to 27.2, p-value 0.011) at six months compared to values obtained at baseline. There was also a fall in the average frequency of sickle cell crises at six months compared to values obtained at baseline (from 7.4 to 3.2, p-value 0.011). Overall, eight out of the ten children showed moderate to good clinical improvement. There was no documentation of any adverse reaction to the medications in any of the children.

Conclusion: The results suggest that the use of nutraceuticals may be beneficial in the management of sickle cell anaemia in children. However, the results are preliminary and will require stronger evidence. There is a need for controlled clinical trials for using larger sample sizes. Such clinical trials of unconventional therapies should be conducted with great care and concern for the safety of the participants.

Keywords: Neutraceuticals, Sickle cell anemia, Clinical score, Aroga immune support, Nigeria

Introduction

Nigeria, being the most populous black nation in the world, bears its greatest burden of sickle cell disease in sub-Saharan Africa.¹ Sickle cell disease is a genetically inherited condition in which the “SS” individual possesses an abnormal beta globin gene. A single base substitution in the gene encoding the human beta globin subunit results in replacement of beta 6 glutamic acid by valine, leading to the clinical manifestations of sickle cell disease. This substitution causes a reduction in the solubility of sickle cell hemoglobin (HbS) when deoxygenated. Sickle cell disease is associated with hemolytic anemia, significant chronic end-organ damage, and early death.² They are also susceptible to any of the different types of sickle cell crises (Table 1). A major goal of management of the disease is to reduce the frequency of acute co-morbidities, sickle cell crises, and to ameliorate chronic complications like anemia, kidney disease, and cardiovascular changes that negatively impinge on the quality of life of those living with the disease.

Conventional treatment of sickle cell anemia includes use of hydroxyurea, folic acid, amino acids supplementation, penicillin prophylaxis, and antimalarial prophylaxis to manage the condition and blood transfusions to stabilize the patient’s hemoglobin level. These are quite expensive and have attendant risk factors.³ The need to explore alternative therapies in people with sickle cell anemia has always been imperative. Nutraceuticals are food or parts of food that provide medical or health benefits. They include botanicals, functional foods and medicinal foods.

There is growing recognition of beneficial effects of nutritional factors and nutraceuticals in the managementm of debilitating chronic diseases.^4,5 A Nutraceutical is a fortified food product that not only supplements the diet but also assists in treatment or prevention of disease. The role of nutraceuticals in ameliorating the clinical complications of sickle cell disease is being evaluated in humans and animal models. Wandersee and colleagues in 2015 reported that docosahexaenoic acid (DHA) supplementation improves RBC flexibility and reduces irreversibly sickled cells by 40% in SS mice.⁶ They concluded that the results point to potential therapeutic benefits of dietary omega-3 fatty acids in Sickle Cell Disease. Docosahexaenoic acid is an omega3 fatty acid found in many water fish, including mackerel, herring, tuna, halibut, salmon, cod liver, and whale blubber. The fatty acid is commonly used for the treatment of heart disease and high blood cholesterol. It is also used for boosting memory and thinking skills, for aiding infant and child development, for certain eye disorders, and many other conditions.⁷ However, there is insufficient scientific evidence to support these uses. In another study, the effects of omega-3 (n-3) fatty acid supplementation in patients with sickle cell anemia was evaluated in a randomized, double-blind, placebo-controlled trial.⁸ The findings of the trial suggest that omega-3 fatty acids can be an effective, safe, and affordable therapy for sickle cell anemia. Several other studies have continued to suggest beneficial effects of Nutraceuticals in the management of sickle cell disease.^9-11

Despite increasing claims to the beneficial effects in sickle cell disease, objective evaluation of nutraceuticals use remains low, especially in developing countries where they are most likely to offer economic advantages in the management of the disease. In Nigeria, use of nutraceuticals in sickle cell disease is almost unexplored. While they continue to play an unregulated secondary role in the management of sickle cell disease, objective scientific evaluation remains scarce. There is thus a need for the development of objective methods useful in the clinical evaluation of the effects of nutraceuticals use in patients with sickle cell disease in developing countries. Here we report some preliminary findings in a small cohort of children with sickle cell disease using a simple, but objective, scoring method for their clinical follow-up and assessment. It is our belief that this guarded approach will add to growing evidence of the beneficial roles of nutraceuticals in the management of sickle cell anemia especially is sub-Saharan Africa.