Sickle Cell Anemia - Supplements

Get support for sickle cell anemia by focusing on your unique nutritional needs. According to research or other evidence, the following self-care steps may be helpful.

Fight back with fish oil
Reduce the frequency of severe pain episodes by taking a daily fish oil supplement providing 33 mg of EPA and 23 mg of DHA for every 2.2 pounds of body weight
Think zinc
Under the supervision of a doctor, take a daily supplement of 100 mg of zinc, plus 2 mg of copper, to help prevent cell damage and speed healing of leg ulcers associated with sickle cell anemia
Fill up on fluids
Drink plenty of water and other fluids to maintain good circulation
Take a test
Have your blood homocysteine levels checked to find out if daily folic acid supplements of 1 to 4 mg are right for you, or to discover if you have a vitamin B12 deficiency that requires treatment

Also indexed as:

hemoglobin SS disease,
SCD,
sickle cell anemia,
sickle cell disease

About this treatment

What Are "Star" Ratings?

a7_3star Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

Supplement	Amount	Why
Fish Oil	250 mg of oil per 2.2 lbs (1 kg) of body weight daily	Supplementing with fish oil appears to reduce the frequency of severe pain episodes.
Fish Oil 250 mg of oil per 2.2 lbs (1 kg) of body weight daily In a preliminary trial, 13 patients with sickle cell anemia were given two supplement combinations for seven to eight months each. The first combination included 109 mg zinc, 153 IU vitamin E, 600 mg vitamin C, and 400 ml (about 14 ounces) of soybean oil containing 11 grams of linoleic acid and 1.5 grams of alpha linolenic acid. The second combination included 140 IU vitamin E, 600 mg vitamin C, and 20 grams of fish oil containing 6 grams of omega-3 fatty acids. Reduction in diseased cells was observed only during the administration of the first protocol. The authors concluded that zinc was the important difference between the two combinations and may be a protector of red blood cell membranes.⁴ Fish oil alone has also been studied. In a double-blind trial, supplementation with menhaden oil, in the amount of 250 mg per 2.2 pounds of body weight per day for one year, reduced the frequency of severe pain episodes by approximately 45%, compared with placebo.⁵ This treatment may work by correcting an imbalance between omega-3 and omega-6 fatty acids that occurs in people with sickle cell anemia.⁶ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Folic Acid (High Homocysteine)	Consult a qualified healthcare practitioner	In one trial, patients with sickle cell anemia who were given folic acid plus aged garlic extract, vitamin C, and vitamin E saw significant improvement and less painful crises.
Folic Acid Consult a qualified healthcare practitioner In a preliminary trial, 20 patients with sickle cell anemia were given either 1 mg of folic acid per day or folic acid plus 6 grams of aged garlic extract, 6 grams of vitamin C, and 1,200 mg of vitamin E per day for six months.⁷ Patients taking the combination had a significant improvement in their hematocrit (an index of anemia) and less painful crises than those taking just folic acid. Preliminary research has found that patients with sickle cell anemia are more likely to have elevated blood levels of homocysteine compared to healthy people.⁸ ^{, 9} Elevated homocysteine is recognized as a risk factor for cardiovascular disease.¹⁰ In particular, high levels of homocysteine in sickle cell anemia patients have been associated with a higher incidence of stroke.¹¹ Deficiencies of vitamin B6, vitamin B12, and folic acid occur more frequently in people with sickle cell anemia than in others¹² ^{, 13} ^{, 14} and are a cause of high homocysteine levels.¹⁵ A controlled trial found homocysteine levels were reduced 53% in children with sickle cell anemia receiving a 2–4 mg supplement of folic acid per day, depending on age, but vitamin B6 or B12 had no effect on homocysteine levels.¹⁶ A double-blind trial of children with sickle cell anemia found that children given 5 mg of folic acid per day had less painful swelling of the hands and feet compared with those receiving placebo, but blood abnormalities and impaired growth rate associated with sickle cell anemia were not improved.¹⁷ In the treatment of sickle cell anemia, folic acid is typically supplemented in amounts of 1,000 mcg daily.¹⁸ Anyone taking this amount of folic acid should have vitamin B12 status assessed by a healthcare professional. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
L-Arginine (Pulmonary Hypertension)	100 mg per 2.2 lbs (1 kg) of body weight, three times per day	People with pulmonary hypertension (a life-threatening complication of sickle cell anemia) who received L-arginine had significant improvement in one study.
L-Arginine 100 mg per 2.2 lbs (1 kg) of body weight, three times per day In a preliminary study, individuals with pulmonary hypertension (a life-threatening complication of sickle cell anemia) received L-arginine in the amount of 100 mg per 2.2 pounds of body weight, three times per day for five days. L-arginine treatment resulted in a significant improvement in pulmonary hypertension, as determined by a 15% decline in the pulmonary artery systolic pressure.¹⁹ Longer-term studies are needed to confirm these preliminary results.

Supplement	Amount	Why
L-Carnitine	50 mg per 2.2 lbs (1 kg) of body weight daily	In a study of children with sickle cell anemia, supplementing with L-carnitine reduced the number of painful crises and improved abnormal heart function and pulmonary hypertension.
L-Carnitine 50 mg per 2.2 lbs (1 kg) of body weight daily In a preliminary study of children with sickle cell anemia, supplementing with L-carnitine (50 mg per 2.2 pounds of body weight per day for six months) significantly reduced the number of painful crises and significantly improved the abnormal heart function (diastolic dysfunction) that was present in most of the children. L-carnitine supplementation also significantly improved pulmonary hypertension in the children who had this abnormality prior to treatment.²⁰ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin B12 (Vitamin B12 Deficiency)	Consult a qualified healthcare practitioner	People with sickle cell anemia may be deficient in vitamin B12. Intramuscular vitamin B12 injections improved symptoms for patients in one study.
Vitamin B12 Consult a qualified healthcare practitioner Sickle cell anemia may result in vitamin B12 deficiency. A study of children with sickle cell anemia found them to have a higher incidence of vitamin B12 deficiency than children without the disease.²¹ A study of 85 adults with sickle cell anemia showed more of them had vitamin B12 deficiency than did a group of healthy people.²² A subsequent preliminary trial demonstrated that for patients with low blood levels of vitamin B12, intramuscular injections of 1 mg of vitamin B12 weekly for 12 weeks led to a significant reduction in symptoms.²³ Researchers do not know whether people with sickle cell anemia who are found to be deficient in vitamin B12 would benefit equally from taking vitamin B12 supplements orally. Preliminary research has found that patients with sickle cell anemia are more likely to have elevated blood levels of homocysteine compared to healthy people.²⁴ ^{, 25} Elevated homocysteine is recognized as a risk factor for cardiovascular disease.²⁶ In particular, high levels of homocysteine in sickle cell anemia patients have been associated with a higher incidence of stroke.²⁷ Deficiencies of vitamin B6, vitamin B12, and folic acid occur more frequently in people with sickle cell anemia than in others²⁸ ^{, 29} ^{, 30} and are a cause of high homocysteine levels.³¹ A controlled trial found homocysteine levels were reduced 53% in children with sickle cell anemia receiving a 2–4 mg supplement of folic acid per day, depending on age, but vitamin B6 or B12 had no effect on homocysteine levels.³² A double-blind trial of children with sickle cell anemia found that children given 5 mg of folic acid per day had less painful swelling of the hands and feet compared with those receiving placebo, but blood abnormalities and impaired growth rate associated with sickle cell anemia were not improved.³³ In the treatment of sickle cell anemia, folic acid is typically supplemented in amounts of 1,000 mcg daily.³⁴ Anyone taking this amount of folic acid should have vitamin B12 status assessed by a healthcare professional. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Zinc	Take under medical supervision: 100 mg of zinc (plus 2 mg of copper daily to protect against depletion)	Supplementing with zinc appears to help prevent cell damage and speed healing of leg ulcers associated with sickle cell anemia.
Zinc Take under medical supervision: 100 mg of zinc (plus 2 mg of copper daily to protect against depletion) Antioxidant nutrients protect the body’s cells from oxygen-related damage. Many studies show that sickle cell anemia patients tend to have low blood levels of antioxidants, including carotenoids, vitamin A, vitamin E, and vitamin C, despite adequate intake.³⁵^{, 36}^{, 37}^{, 38}^{, 39}^{, 40} Low blood levels of vitamin E in particular have been associated with higher numbers of diseased cells in children⁴¹ and with greater frequency of symptoms in adults.⁴² A small, preliminary trial reported a 44% decrease in the average number of diseased cells in six sickle cell anemia patients given 450 IU vitamin E per day for up to 35 weeks. This effect was maintained as long as supplementation continued.⁴³ In another preliminary trial, 13 patients with sickle cell anemia were given two supplement combinations for seven to eight months each. The first combination included 109 mg zinc, 153 IU vitamin E, 600 mg vitamin C, and 400 ml (about 14 ounces) of soybean oil containing 11 grams of linoleic acid and 1.5 grams of alpha linolenic acid. The second combination included 140 IU vitamin E, 600 mg vitamin C, and 20 grams of fish oil containing 6 grams of omega-3 fatty acids. Reduction in diseased cells was observed only during the administration of the first protocol. The authors concluded that zinc was the important difference between the two combinations and may be a protector of red blood cell membranes.⁴⁴ Fish oil alone has also been studied. In a double-blind trial, supplementation with menhaden oil, in the amount of 250 mg per 2.2 pounds of body weight per day for one year, reduced the frequency of severe pain episodes by approximately 45%, compared with placebo.⁴⁵ This treatment may work by correcting an imbalance between omega-3 and omega-6 fatty acids that occurs in people with sickle cell anemia.⁴⁶ The zinc deficiency associated with sickle cell anemia appears to play a role in various aspects of the illness. For example, preliminary research has correlated low zinc levels with poor growth in children with sickle cell anemia.⁴⁷ In a preliminary trial, 12 people with sickle cell anemia received 25 mg of zinc every four hours for 3 to 18 months.⁴⁸ The number of damaged red blood cells fell from 28% to 18.6%. Addition of 2 mg of copper per day did not inhibit the effect of zinc. (Zinc supplementation in the absence of copper supplementation induces a copper deficiency.) Patients with the highest number of damaged red blood cells had a marked response to zinc, but those with lower levels of damaged cells (less than 20% irreversibly sickled cells) had little or no response. Chronic leg ulcers occur in about 75% of adults with sickle cell disease. In a controlled trial, sickle cell patients with low blood levels of zinc received 88 mg of zinc three times per day for 12 weeks.⁴⁹ Ulcer healing rate was more than three times faster in the zinc group than in the placebo group. Zinc supplementation (25 mg 3 times per day for 3 months) also decreased the number of infections in adults with sickle cell anemia.⁵⁰ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Beta-Carotene	Refer to label instructions	Sickle cell anemia patients tend to have low levels of antioxidants, which protect cells from oxygen-related damage. Supplementing with beta-carotene may help correct a deficiency.
Beta-Carotene Caution: Synthetic beta-carotene has been linked to increased risk of lung cancer in smokers. Until more is known, smokers should avoid all beta-carotene supplements. Antioxidant nutrients protect the body’s cells from oxygen-related damage. Many studies show that sickle cell anemia patients tend to have low blood levels of antioxidants, including carotenoids, vitamin A, vitamin E, and vitamin C, despite adequate intake.⁵¹^{, 52}^{, 53}^{, 54}^{, 55}^{, 56} Low blood levels of vitamin E in particular have been associated with higher numbers of diseased cells in children⁵⁷ and with greater frequency of symptoms in adults.⁵⁸ A small, preliminary trial reported a 44% decrease in the average number of diseased cells in six sickle cell anemia patients given 450 IU vitamin E per day for up to 35 weeks. This effect was maintained as long as supplementation continued.⁵⁹ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Garlic	Refer to label instructions	In one trial, patients with sickle cell anemia who were given folic acid plus aged garlic extract, vitamin C, and vitamin E saw significant improvement and less painful crises.
Garlic In a preliminary trial, 20 patients with sickle cell anemia were given either 1 mg of folic acid per day or folic acid plus 6 grams of aged garlic extract, 6 grams of vitamin C, and 1,200 mg of vitamin E per day for six months.⁶⁰ Patients taking the combination had a significant improvement in their hematocrit (an index of anemia) and less painful crises than those taking just folic acid. What Else Is This Supplement Used For?

Supplement	Amount	Why
Magnesium	Refer to label instructions	In one trial, supplementing with magnesium dramatically reduced the number of painful days for people with sickle cell anemia.
Magnesium Low concentrations of red blood cell magnesium have been noted in patients with sickle cell anemia.⁶¹ ^{, 62} Low magnesium, in turn, is thought to contribute to red blood cell dehydration and a concomitant increase in symptoms. In a preliminary trial, administration of 540 mg of magnesium per day for six months to sickle cell anemia patients reversed some of the characteristic red blood cell abnormalities and dramatically reduced the number of painful days for these patients.⁶³ The form of magnesium used in this trial, magnesium pidolate, is not supplied by most magnesium supplements; it is unknown whether other forms of magnesium would produce similar results. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin A	Refer to label instructions	Sickle cell anemia patients tend to have low levels of antioxidants, which protect cells from oxygen-related damage. Supplementing with vitamin A may help correct a deficiency.
Vitamin A Antioxidant nutrients protect the body’s cells from oxygen-related damage. Many studies show that sickle cell anemia patients tend to have low blood levels of antioxidants, including carotenoids, vitamin A, vitamin E, and vitamin C, despite adequate intake.⁶⁴^{, 65}^{, 66}^{, 67}^{, 68}^{, 69} Low blood levels of vitamin E in particular have been associated with higher numbers of diseased cells in children⁷⁰ and with greater frequency of symptoms in adults.⁷¹ A small, preliminary trial reported a 44% decrease in the average number of diseased cells in six sickle cell anemia patients given 450 IU vitamin E per day for up to 35 weeks. This effect was maintained as long as supplementation continued.⁷² What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin B6	Refer to label instructions	Vitamin B6 has been shown to have anti-sickling effects on the red blood cells. It can also correct vitamin B6 deficiency, which is common in people with sickle cell anemia.
Vitamin B6 Preliminary research has found that patients with sickle cell anemia are more likely to have elevated blood levels of homocysteine compared to healthy people.⁷³ ^{, 74} Elevated homocysteine is recognized as a risk factor for cardiovascular disease.⁷⁵ In particular, high levels of homocysteine in sickle cell anemia patients have been associated with a higher incidence of stroke.⁷⁶ Deficiencies of vitamin B6, vitamin B12, and folic acid occur more frequently in people with sickle cell anemia than in others⁷⁷ ^{, 78} ^{, 79} and are a cause of high homocysteine levels.⁸⁰ A controlled trial found homocysteine levels were reduced 53% in children with sickle cell anemia receiving a 2–4 mg supplement of folic acid per day, depending on age, but vitamin B6 or B12 had no effect on homocysteine levels.⁸¹ A double-blind trial of children with sickle cell anemia found that children given 5 mg of folic acid per day had less painful swelling of the hands and feet compared with those receiving placebo, but blood abnormalities and impaired growth rate associated with sickle cell anemia were not improved.⁸² In the treatment of sickle cell anemia, folic acid is typically supplemented in amounts of 1,000 mcg daily.⁸³ Anyone taking this amount of folic acid should have vitamin B12 status assessed by a healthcare professional. In test tube studies, vitamin B6 has been shown to have anti-sickling effects on the red blood cells of people with sickle cell anemia.⁸⁴ ^{, 85} Vitamin B6 deficiency has been reported in some research to be more common in people with sickle cell anemia than in healthy people.⁸⁶ ^{, 87} In a controlled trial, five sickle cell anemia patients with evidence of vitamin B6 deficiency were given 50 mg of vitamin B6 twice daily. The deficiency was reversed with this supplement, but improvement in anemia was slight and considered insignificant.⁸⁸ Therefore, evidence in support of vitamin B6 supplementation for people with sickle cell anemia remains weak. What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin C	Refer to label instructions	Sickle cell anemia patients tend to have low levels of antioxidants, which protect cells from oxygen-related damage. Supplementing with vitamin C may help correct a deficiency.
Vitamin C Antioxidant nutrients protect the body’s cells from oxygen-related damage. Many studies show that sickle cell anemia patients tend to have low blood levels of antioxidants, including carotenoids, vitamin A, vitamin E, and vitamin C, despite adequate intake.⁸⁹^{, 90}^{, 91}^{, 92}^{, 93}^{, 94} Low blood levels of vitamin E in particular have been associated with higher numbers of diseased cells in children⁹⁵ and with greater frequency of symptoms in adults.⁹⁶ A small, preliminary trial reported a 44% decrease in the average number of diseased cells in six sickle cell anemia patients given 450 IU vitamin E per day for up to 35 weeks. This effect was maintained as long as supplementation continued.⁹⁷ In another preliminary trial, 13 patients with sickle cell anemia were given two supplement combinations for seven to eight months each. The first combination included 109 mg zinc, 153 IU vitamin E, 600 mg vitamin C, and 400 ml (about 14 ounces) of soybean oil containing 11 grams of linoleic acid and 1.5 grams of alpha linolenic acid. The second combination included 140 IU vitamin E, 600 mg vitamin C, and 20 grams of fish oil containing 6 grams of omega-3 fatty acids. Reduction in diseased cells was observed only during the administration of the first protocol. The authors concluded that zinc was the important difference between the two combinations and may be a protector of red blood cell membranes.⁹⁸ Fish oil alone has also been studied. In a double-blind trial, supplementation with menhaden oil, in the amount of 250 mg per 2.2 pounds of body weight per day for one year, reduced the frequency of severe pain episodes by approximately 45%, compared with placebo.⁹⁹ This treatment may work by correcting an imbalance between omega-3 and omega-6 fatty acids that occurs in people with sickle cell anemia.¹⁰⁰ What Else Is This Supplement Used For? See Drug Interactions

Supplement	Amount	Why
Vitamin E	Refer to label instructions	Low vitamin E levels have been associated with higher numbers of diseased cells in children and with greater symptom frequency in adults. Supplementing with the vitamin can help restore levels.
Vitamin E Antioxidant nutrients protect the body’s cells from oxygen-related damage. Many studies show that sickle cell anemia patients tend to have low blood levels of antioxidants, including carotenoids, vitamin A, vitamin E, and vitamin C, despite adequate intake.¹⁰¹^{, 102}^{, 103}^{, 104}^{, 105}^{, 106} Low blood levels of vitamin E in particular have been associated with higher numbers of diseased cells in children¹⁰⁷ and with greater frequency of symptoms in adults.¹⁰⁸ A small, preliminary trial reported a 44% decrease in the average number of diseased cells in six sickle cell anemia patients given 450 IU vitamin E per day for up to 35 weeks. This effect was maintained as long as supplementation continued.¹⁰⁹ In another preliminary trial, 13 patients with sickle cell anemia were given two supplement combinations for seven to eight months each. The first combination included 109 mg zinc, 153 IU vitamin E, 600 mg vitamin C, and 400 ml (about 14 ounces) of soybean oil containing 11 grams of linoleic acid and 1.5 grams of alpha linolenic acid. The second combination included 140 IU vitamin E, 600 mg vitamin C, and 20 grams of fish oil containing 6 grams of omega-3 fatty acids. Reduction in diseased cells was observed only during the administration of the first protocol. The authors concluded that zinc was the important difference between the two combinations and may be a protector of red blood cell membranes.¹¹⁰ Fish oil alone has also been studied. In a double-blind trial, supplementation with menhaden oil, in the amount of 250 mg per 2.2 pounds of body weight per day for one year, reduced the frequency of severe pain episodes by approximately 45%, compared with placebo.¹¹¹ This treatment may work by correcting an imbalance between omega-3 and omega-6 fatty acids that occurs in people with sickle cell anemia.¹¹² What Else Is This Supplement Used For? See Drug Interactions

References

Last Review: 05-11-2011

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2011.

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