VITAMIN C - Ascorbic Acid

Now, if you just started singing the nursery rhyme “‘A’ is for apple, ‘B’ for boy, ‘C’ for cat…where did ascorbic acid come in?”, you must have been that guy dozing in front of me in class or that chic passing notes about so & so’s crush on nani. So before you start questioning the title & I’m accused of speaking jargon, let’s talk about vitamin C a.k.a (also scientifically known as) “ascorbic acid” –the word comes from the New Latin word "scorbutus" meaning scurvy.

Vitamin C is a water-soluble vitamin that we get from our food. Our bodies can neither make vitamin C nor can they store it for later use. Which is why we need to ingest as much of it as possible. However, some animals (mostly carnivores) can make their own vitamin C. This is why lions, leopards, cheetahs & the other cats do just fine without fruits & veggies.

Good sources of vitamin C are fresh fruits and vegetables, especially citrus fruits (like oranges, tangerines, grapefruit & pineapples), strawberries, tomatoes, sweet potatoes (ngwaci), sweet bell peppers (hoho nyekundu na manjano), kales (sukuma wiki) and potatoes. Vitamin C can also be artificially made into tablet supplements. I recommend getting vitamin C from a diet high in fruits and vegetables rather than taking the tabs. Supplementation, especially when not prescribed by a health expert can lead to toxicity/ over-dosage of vitamin C, which in turn has its consequences especially in sickle cell disease.

Vitamin C is one of the most popular micronutrients known to man. Even before its discovery in 1932, nutrition experts back in the day recognized that something in citrus fruits could prevent scurvy, a disease that killed as many as two million sailors, pirates and others who spent long periods of time onboard ships between 1500 and 1800. When the voyages lasted longer than the supply of fruits and vegetables, the sailors began to suffer from vitamin C deficiency, which led to scurvy. Scurvy is known as the bleeding gums disease, because vitamin C helps to make collagen, a tissue needed for healthy bones, teeth, gums and blood vessels. (P.S: if you have any bleeding gums, don’t panic! There is more to scurvy & probably all you need to do is change your toothbrush).

But I’m sure we’ve all first heard of the vitamin when it came to preventing or treating the common cold. Let me refresh your memory, remember when you had a cold & your mum made you drink that bitter concoction of lemon, ginger, garlic & honey (if you’re lucky)? Yeah, that drink she made you gobble down while holding a slipper in her hand, because it worked for her mum & mum’s mum & the shosho of her mum’s mum’s dad? It actually didn’t begin in your lineage, but in the 1970s when Chemistry and Peace Nobel laureate, Linus Pauling promoted daily mega doses of vitamin C (the amount in 12 to 24 oranges) as a way to prevent colds and some chronic diseases. I don’t know about you but I’d rather have shosho’s drink than a dozen oranges in a day…yikes! My taste buds are already getting zingy.

There’s no question that vitamin C plays a role in controlling infections & maintaining proper immune function. We know this is very very important in sickle cell disease. The question is, do we need lots of vitamin C to keep you healthy?

No. Vitamin C’s cold-fighting potential certainly hasn’t panned out. Small trials suggest that the amount of vitamin C in a typical multivitamin taken at the start of a cold might ease symptoms, but for the average person there’s no evidence that mega doses make a difference, or that they prevent colds. It doesn’t sound like it’s living up to its legendary health boosting name when it comes to sickle cell disease, is it?

That’s because most people don’t know it is also a powerful antioxidant that can neutralize harmful free radicals (like germs, viruses, toxins) & protect red blood cell membranes against oxidative damage. Research has shown that sickle cell warriors have low levels of vitamin C in their blood as a result of the disease. If you have low vitamin C (the antioxidant) in your blood, then there will be an increased vulnerability of sickle cells to oxidant damage by the free radicals. This vitamin even goes the extra mile to regenerate other antioxidant buddies like vitamin E. More so, vitamin C increases the absorption of iron from foods in the body; thus replacing any lost iron from sickling of red blood cells. Super! Right?

You can always get the most of this vitamin out of foods by the way you prepare your meals. Since it’s water-soluble, it can easily leach out of fruits & vegetables when washing or cooking. As Kenyans, we mostly have the habit of buying thinly sliced mboga from the soko and immediately giving the shredded strips a thorough wash when we get home. As if that is not enough to get rid of the bacteria we’ve pictured, we cook the veggies until they lose their green crunchy nature to a swampy murky appearance. When we wash our veggies & fruits after they’ve already been sliced, we increase the surface area for their loss through the water being used. And when we over-cook our veggies, the heat evaporates their nutrient-dense fluids; we might as well be eating the empty calories in sweeteners & what not. Other tricks to get more vitamin C from food simply involve choosing fresh foods to eat. For example, a fresh-squeezed orange juice is a better pick than ready-to-drink orange juice, because the fresh juice contains more active vitamin C & no added chemicals or sugars. Better yet, eat the whole fruit! You’ll benefit from the fiber too.

Do you see what’s going on here? Nature is once again curing what ails us. Not the doctors, not the pills. The earth was designed with built-in solutions to our health problems. As our bodies crave healing, the seasons provide all the natural medicine we need. Keep it healthy!

Love life!

Sharlene M.M.

NUTRITION - MYTHS & FACTS

Is it a FACT or a FAD? 

These are two things we always tend to ask ourselves when it comes to what we eat.

It is well known that eating right can extend lives, but what 'eating right' entails isn't always clear. What are some of the myths and facts of nutrition in our normal lives?

Here are some lessons and facts to learn from and apply them in our day to day lives.

Love Life!

Sharlene & Ruth.

LET’S GET SOME ENERGY!!!!

‘You need to finish your food. You need the energy.’
Now am sure we've all heard this phrase more than a million times especially when eating was, well, the last thing on our minds. Like when you are in the middle of a game of snakes and ladders and you were well on your way to winning. So what was the fuss all about? I mean we can eat anything and at any time? I’ll still be ok? Right?



Sufficient energy is important for good health. Energy is needed by the body to carry out activities.
Muscle movement, breathing, healthy heartbeats and even thinking need energy. When these body
functions are doing well we are able to carry out chores, duties, daily activities and exercise well. This promotes proper growth and development.

The main source of energy for the body is carbohydrates. The body can also get energy from fats and
proteins. The Red blood cells utilize glucose only. The brain and nerve cells rely primarily on glucose. Fat is used when we are resting or doing low-intensity activities like sitting. The Red blood cells and brain cells will still use glucose when we are at rest. Proteins are used when carbohydrates and fats are not enough to give energy like during long periods of starvation. So where is the challenge when I have Sickle Cell Anemia?

In Sickle cell anaemia, there is insufficient energy for the body to work well. A lot more energy is used to carry out the same activities as everyone else. One of the major reasons is poor appetite. A poor appetite will make us not eat enough food to give us energy. The glucose we get is not used efficiently by the cells. The hemoglobin which is already too little will be bound to the free glucose in the blood. As a result of this, the hemoglobin will package and carry little oxygen for us to use. Low energy makes it difficult for the red blood cells to have healthy membranes. The membrane becomes rigid and breaks down fast. Finally, the body organs are overworked and organ-specific disease like kidney disease can develop. Is there a way to make sure I have enough energy?

Taking good care of ourselves involves making wise food choices. The one thing we need to maintain is steady supply energy for the body. This way we can fuel our daily activities efficiently and carry them out with ease. And how can I do this?

 Eat whole grain foods with a low glycemic load. Unlike refined white and overcooked foods, Wholegrain foods provide us with sufficient energy through the day. They do this by slowly releasing glucose into our body system.  This way, the blood glucose level rises steadily but slowly. The body can utilize the glucose efficiently as the system is not overloaded.

 Have a high calorie-nutrient dense diet. This can be achieved by eating carbohydrate foods with
low glycemic load with protein. For example, we can have chicken with brown basmati rice or
scrambled eggs and whole grain rye bread. High fibre meals like brown rice with beans also
lower the glycemic load. Use vegetable oils like olive oil and sesame oil that have beneficial fatty
acids that prevent heart disease.

 Vegetables. Dark green leafy and root vegetables should be part of our diet. They can be eaten
raw or cooked with five servings per day being good enough. Dark leafy vegetables provide
micronutrients that help us utilize glucose. Root vegetables like cassava and sweet potato provide us with glucose. Vegetables provide us with fibre that slows digestion of carbohydrates.

 Fruits. Three or more servings of fruit daily will contribute to our energy needs. Fresh fruits and
fresh fruit juice are better sources than canned or dried fruits. They keep our tummies filled for longer. Diluted fruit juices and dried fruits should be eaten less frequently and in small
quantities.

 Healthy habits and Sugar alternatives. Foods with refined sugar like ice cream provide us with a
burst on energy and soon we are left with cravings for more sugar and bouts of hunger. Avoid caffeinated drinks like tea and energy drinks as they have a similar effect. We can have fruit
instead of desert and also add some to breakfast cereal to sweeten it. Fruits, nuts and seeds are
healthier snacks. You can have untreated honey instead of sugar. Heat treated sugar has a fast
releasing sugar like glucose that we want to avoid.

 Meal Portions. It is better to take little and often meals than ‘gorge’ on large and greatly spaced
meals. This caters for the needs of a poor appetite. It encourages us to eat just what we can at a
time but also get energy. The body also breaks down the carbohydrates little by little so it is not
over worked.

 Exercise. Sweat inducing exercise like biking are recommended. The sweat is the body’s way of
removing waste products from the activities it does. This will ensure that major body fluids have an alkaline pH conducive for energy extraction.


Well guys, I am sure we will be getting the most of our days with all the energy in the room!! Till
then Hydrate! Hydrate! Hydrate!! Water is Life!!

N.B: Kindly consult the Food Pyramid and Food Composition table for the food servings.


Love Life!

Joyner.

FOLIC ACID AND SICKLE CELL ANAEMIA

Sickle Cell Anaemia as seen earlier adversely affects the production and the quality of red blood cells. The cells have a shorter lifespan. This leads to increased folic acid losses. Today we focus on this vitamin and its importance. Let’s begin, Shall we?

Folic acid, also called folate, is a B vitamin. It is referred to as Vitamin B9. The name is derived from the Latin name foliage meaning ‘leaf’. This is because folate is found in highest levels in green leafy vegetables. Folic acid can be artificially synthesized. It is used in food fortification and manufacture of supplements.

Folic acid plays a key role in certain body functions. Folic acid is critical for nucleotide synthesis. It is essential for protein utilization and red blood cell synthesis. Folic acid works well with other B vitamins especially vitamin B12. Now let us look into each of these roles and consequences of deficiency in more detail.

·         NUCLEOTIDE SYNTHESIS. Folic acid is required for the synthesis of purines and thymidine. These are important for DNA synthesis. DNA controls cell division in growth and development. Folic acid is crucial for pregnant women during the first four weeks. This ensures proper development of the brain and nerves from the neural tube that is formed by the 28^th day of pregnancy. Folate is needed on in life to maintain the integrity of body tissues and repair. Folic acid deficiency in pregnancy leads to neural tubal defects like spina bifida in newborns. It is of great importance that all women of childbearing age take adequate folate (additional 400mcg aside dietary folate) regardless of whether or not they intend to get pregnant.

·         PROTEIN UTILIZATION. Proteins are made of many smaller units called amino acids. Folic acid is needed for the metabolism of various amino acids including glycine, serine and methionine. Folic acid, together with Vitamins B6 and B12 are important in methionine metabolism. Folate and B12 convert homocysteine to methionine while B6 converts homocysteine to cysteine. High levels of homocysteine are associated with vascular disease. The role of folic acid is cemented in the regulation of these diseases through homocysteine regulation.

·         RED BLOOD SYNTHESIS. As we saw earlier, folic acid is important for DNA synthesis. DNA controls the production of red blood cells. In sickle cell anaemia because the red blood cells are short-lived, the levels of folate in the body are often low. As a result, DNA synthesis is impaired and the red blood cells fail to divide well. They remain as large immature precursors of the red blood cells. This condition is referred to as megaloblastic anaemia. These cells have little haemoglobin. They cannot package and transport oxygen sufficiently. Because of the anaemia, one may be anxious, lack energy, have a poor appetite, stomach pains, and cracked lips. You may also suffer from depression. This deficiency severs the sickle cell condition because the red blood cell levels are already too low and crescent shaped cells are predominant.

We need to have a daily balanced diet to be provided with adequate folic acid. This is to prevent folate deficiency. Green leafy vegetables are highly recommended. Some good sources are spinach, cauliflower and sprouts. Whole grains, lentils and pinto beans can be included in the diet. Red meats like beef liver are rich in folic acid but should be eaten in minimal amounts. The red meats are rich in saturated fats hat are bad for our health. This is because they contribute to development of vascular disease. Folic acid is heat sensitive therefore we are advised to eat fresh, uncooked vegetables and fruits. Avocado, beets, sesame nuts (simsim) and cashew nuts are good sources of such. Enriched cereals are also encouraged.

While a balanced diet provides enough folic acid, your doctor or nutritionist may recommend that you take daily folic acid supplements.

This is to cover the losses due to red blood cell death as well as slow metabolism by the body. The supplement tablets should provide between 400-1000 micrograms of folic acid daily. Majority of  patients have a high-dose folic acid  prescription of 1000mcg(1mg) daily. In some cases a B-complex supplement may be given. This particularly true when one has vitamin B12 deficiency, pernicious anaemia.*Folic acid can clear the blood signs of B12 deficiency and hide the neurological signs masking the deficiency. Vitamin B12 is needed for growth and maintenance of the insulating myelin sheath around nerve fibres. Only a skilled professional can diagnose the nutrient deficiency. Self-diagnosis and advice from unskilled self-proclaimed experts are not advised. Well, that’s folic acid for you. Remember to take you greens, drink your water and exercise to stay in tip-top shape.

*The exact doses of folic acid taken by patients that hide B12 deficiency are still subject to research.

Love Life!!
Joyner

SICKLE CELL SYMPTOMS & CLINICAL MANIFESTATIONS

How do you know one has Sickle Cell just by looking at them? How does Sickle Cell Disease look like?

I could say, jaundiced (yellow) eyes/skin, small physical stature, swollen abdomens etc. . But to truthfully answer your question, there is no particular way to tell if someone has Sickle Cell by just looking at them. Unless you're a keen observer and are very versed in the knowledge of Sickle Cell and its symptoms. Sickle Cell has no particular face.

Well, since it has no particular identifier, like any disease, there are definitely certain symptoms to look out for if you have Sickle Cell. Granted that human beings are different in there physiological make-up, these symptoms vary from one individual to the next. This means that, not everyone with Sickle Cell will exhibit the same symptoms. Different people may only experience a few or even in some cases none at all. In very rare cases does one person exhibit all of the symptoms.

Sickle Cell Symptoms

These clinical manifestations and symptoms result from changes of red blood cell deformability and fragility, increases in blood viscosity with blockage of small blood vessels, and red cell membrane changes contributing to hemoglobin polymerization(clumping), adherence of red blood cells to interior surface of blood vessels, and ingestion of foreign material by white blood cells. The end result is a hemolytic anemia, increased incidence of serious infection, and ischemic damage (damage caused by restriction of blood supply) throughout the body. In individuals with Sickle syndromes, there is a life-long risk of having complications,  however, there are specific ages when many of the manifestations develop. The more common problems in Sickle Cell syndromes will be presented by the age usual onset.

Early Symptoms
The majority of infants are being diagnosed at birth by newborn screening. The symptoms occurring in the first few months of life in infants with sickle cell syndromes are non-specific and include jaundice, irritability, colic, failure to thrive, fever, nausea, and vomiting. Findings include hepatosplenomegaly (simultaneous enlargement of live and spleen), pallor (unhealthy pale appearance), and heart murmurs. Unfortunately, undiagnosed infants may present with overwhelming infection as the first manifestation of the illness in the first few months of life.

Other Symptoms

• Anemia
• Sequestration Episode
• Aplastic Episode
• Infections
• Dactylitis : The Hand-Foot Syndrome
• Strokes
• Priapism
• Growth & Development
• Pain : Acute and Chronic Pain
• Retinopathy
• Nephropathy
• Pulmonary Complications
• Leg Ulcers 

In the next couple of weeks we will discuss each of the different symptomatic expressions of Sickle Cell. We will go into the causes of said symptom and how to manage the symptom.These are the most common symptoms which occur in many recorded cases. Personally, I have experienced very few of the symptoms above and also other symptoms that are not on the list. I'll be sure to give a brief on my experiences as we go through each of the symptom.

Sickle Cell Clinical Manifestations 

Have you experienced any of the symptoms above? Let me know your experience and how you were able to manage it. And if you feel I have missed something, comment below and let me know what I need to add onto the list.


Love Life!
Lea

NUTRITION MYTHS IN SICKLE CELL ANAEMIA

Hey people, I hope you've been learning tones from what we've had on the blog so far. But our journey has only quite begun and it’s going to get more exciting. This week we will debunk at some of the nutrition myths surrounding SCA. It’s important to separate facts from fiction so than we are able to make wise decisions.

Let’s start!! Shall we??

1.       Medication is the only way to treat SCA. While it is important to follow a medical treatment regimen, it is equally important to ensure that SCA patients get adequate nutrition. It is important that their meals should be nutrient dense: adequate calories, proteins, fats, vitamins and minerals. They should also take not less than 2l of fluids daily.

2.       Iron supplements can treat the disease because the patients are anemic. Anaemia in SCA is a symptom. It is not caused by iron deficiency but difficulties in transporting or processing the iron. The use of iron supplements will also cause toxicity from a iron overload that will promote development of infection. Unbound Iron behaves like free radicals and these may lead to further organ damage.

3.       SCA is a genetic disorder and our fate is already sealed. This is false and SCA patients can have prolonged lives. Though we have little control of the disease’s expression, we can manage it by following the doctor’s instructions, taking medication, eating healthy and doing light exercises. This ensures that the body is able to fight of infections much better and reduce frequency and intensity of frequency.

4.       Animal proteins are rich in iron, the more I eat the better. While animal protein has significantly lower but adequate iron levels it may contribute to further complications especially of the liver. You cannot get toxicity from iron rich foods but in the case of SCA, when iron is assimilated from food, a small amount is taken up by the body. The excess must be removed by the liver which may be already overworked. This contributes to liver damage among other complications.

Remember proteins are still important for good health. They should not be completely eliminated but regulated. 

Food is important in maintenance of a good health status and it is crucial to know what we eat and how it is used by the body.

Well there you have it. 

Till next time,

Love life!!

Joyner 

TO ADHERE TO TREATMENT SICKLE CELL PATIENTS NEED TO BE EDUCATED

In her debut memoir Living with sickle cell disease: The struggle to survive, Judy Gray Johnson 72, one of the longest living person with Sickle Cell Disease recollects that she was 16 years in 1959 when she had gone with her aunt to a doctor who diagnosed her with Sickle Cell Disease. She writes that the social mores of that time dictated that adults discussed nothing of substance with children. She was never told anything concerning Sickle Cell Disease.

It may seem that was for the 1950s or for the last century and never crossed into the 21st Century (2000s) or the information age. That has not been the case, in 2002 when I was first diagnosed with sickle cell 43 years after Judy was diagnosed it was the same story for me..

"That’s a universal situation. Most Sickle Cell patients lack knowledge about their condition"

I was 12 years then, when the doctor handed the results to my father nothing was taught to me about the disease I was going to live with for the rest of my life. It was only the cocktail of drugs prescribed after the diagnosis that was explained to me.

Were these people reading the same script? It’s the question I still ask myself.

That’s a universal situation. Most Sickle Cell patients lack knowledge about their condition. Some patients finds themselves in dilemma when they don’t know the symptoms, warning signs when a crisis is going to happen and what to do to arrest a crisis.

Patients with Sickle Cell need to be better educated about their health. Most are less likely to get accurate information about their disease. One mother to a Sickle Cell warrior daughter shared her experience with a nurse; she revealed that a nurse who even treats other Sickle Cell warriors told her that Sickle Cell is infectious and any person can get it even later in life. If a medical personnel can give unforgivable information like this, I don’t this this nurse can give correct information about treatment and how to avoid a crisis.

"The most difficult stage for people living with Sickle Cell Disease is transition from pediatric to adulthood. Because previously it was difficult to find many adults living with the disease,"

Still some of the patients lack a better understanding of many symptoms of Sickle Cell and there is a need for improved patient education. Improving patients understanding about why a particular treatment is important for an individual situation may lead to more informed decisions and better adherence to treatment.

A better comprehension of one’s symptoms and reasons for personalized treatment recommendations also could improve a patient’s trust, confidence and satisfaction with primary treatment provider.

The most difficult stage for people living with Sickle Cell Disease is transition from pediatric to adulthood. Because previously it was difficult to find many adults living with the disease, so all the efforts and resources were channeled to caring for children with Sickle Cell. The situation has now changed and sicklers progress to adulthood.

So now there is a need to have a special education programme for adolescent and adult patients. The programme needs to cover issues like the reasons for taking daily drugs, different pain coping methods and reasons for delayed growth. This can also reduce on the stress experienced by most teens.

A comprehensive patient education program can focus on connecting adult patients with sickle cell disease with primary care providers and support the relationship. Help older adolescents and young adults with Sickle Cell Disease to transition smoothly from pediatric to adult primary care doctors and finally primary care providers to care for people with sickle cell disease of all ages and provide necessary tools to deliver high quality care.

Love Life!

Ssebandeke Ashiraf

Catch up with me HERE where you can read more of my written pieces on Sickle Cell Disease.