Let me start with some background about what can occur even in thal minor. Because some of the red blood cells that minors produce are small and irregularly shaped, there is a higher than normal turnover of RBCs. This is called hemolysis, and in turn this leads to an increase in spleen size, as the spleen breaks down the RBCs. This also leads to higher bilirubin levels and a build up of sludge in the gallbladder. Eventually, this can cause great pain and even pose a threat of rupture. Even if the gallbladder is removed, the hemolysis continues. The breakdown of RBCs causes much oxidative stress in the body, requiring antioxidants to counter the effects of oxidation. This process also depletes many nutrients in the body. Replacing the nutrients and concentrating on antioxidants, both in supplement and dietary forms is essential for good health.
My recommendations for thal minors follow.
Follow a nutritious diet that avoids foods with no nutritional value as much as possible. Think antioxidants when choosing foods. Fresh fruit, vegetables, nuts and beans are all good sources of antioxidants. Search online for "antioxidant foods" for more ideas. I cannot emphasize the importance of a high antioxidant diet enough. In all forms of thalassemia, oxidation is a real threat to health and this should always be kept in mind.
Exercise should be mild to moderate. This may mean something as simple as a short daily walk. the more you can exercise your legs, the healthier your heart will be and the less chance you will have of experiencing restless leg syndrome. A combination of improved diet and mild exercise should eventually lead to an ability to deal with a higher level of exercise.
Supplements:
Absolutely necessary are-
Folate 1-2 mg daily. Thal minor women trying to get pregnant or pregnant should be on doses of 2-5 mg daily. Folic acid is a basic building block of RBCs and it is essential in all forms of thal. The better form to use is l-methylfolate, as it is more bioavailable and many people cannot process folic acid properly. Studies have shown that women in general maintained higher Hb levels during pregnancy than those who used folic acid.
http://www.ncbi.nlm.nih.gov/pubmed/21440300 CONCLUSIONS:
In the present study, supplementation with a prenatal medical food containing L-methylfolate and high-dose vitamin B(12) may maintain hemoglobin levels and decrease rates of anemia in pregnancy more effectively than standard prenatal vitamins
Natural vitamin E complex. Use only natural d-tocopherol and mixed tocopherols. Do not use dl-tocopherol. It is synthetic and may actually be harmful in most doses. Take 400 IU natural E daily. This is one of the most important antioxidants you can take and it is good for the lungs and circulatory system. It also slows the aging process.
Vitamin C 500-1000 mg daily. (This dose should not be taken by thal majors). Vitamin C is also a powerful antioxidant, which also has the property of being able to reactivate vitamin E after E has already been used by the body as an antioxidant, making the E even more valuable. C is also essential for the circulatory system, as it is needed for the integrity of the walls of blood vessels. If you bruise easily, you are most likely deficient.
Magnesium 250-500 mg daily. In women, it is advised to take with calcium in a 2:1 ratio of Cal to Mag. Anyone experiencing heart palpitations should take cal/mag daily as these two minerals control the two sides of the heart beat. An imbalance or deficiency can lead to palps. Magnesium is also needed to build RBCs and deficiency is often a cause of restless leg syndrome.
B Complex (100 is recommended). Essential for building RBCs and maintaining energy levels. B vitamins are water soluble and need to be constantly replenished. The modern diet does not provide enough B vitamins.
Vitamin D levels should be checked in anyone experiencing tiredness or fatigue. D deficiency is the most common deficiency in today's world, with 1/2 to 2/3 of the world's population deficient. Get tested. If your level is not at least 35, correction is needed. Throw out any information about vitamin D that is more than 5 years old. It is now recognized that doses of at least 5000 IU daily are required daily to budge the level. Often, doses of 50,000-60,00 IU are prescribed weekly. Deficiency is behind a host of health issues, as D is essential for most minerals and many vitamins to be properly absorbed and used by the body. Taking minerals without taking D is almost useless. D deficiency is implicated in anything from a low immune system to depression. Get tested if you haven't already done so. No exceptions here, unless you get daily exposure to the sun year round (this mean short sleeves for over an hour a day).
Optional:
Trace minerals like selenium, zinc and copper should be considered, especially if the diet does not include a wide variety of nutritious foods.
CoQ10, glutathione, Alpha Lipoic Acid and L-carnitine (or L-arginine or L-citrulline) can also be considered. Patients finding they get more tired as they age should definitely use L-carnitine.