Dear Richard,


Thank you for your UpToDate information to this forum!


Have a nice day and kind regards,


Esther Grasmeijer

The Netherlands




Van: []
Namens Favism Mailing List
Verzonden: maandag 5 februari 2018 15:59
Onderwerp: Re: [Favismlist] G6pd question


Dear Helene,

I recommend that you speak with a physician knowledgeable about G6PD with
your questions. The information below is taken from UpToDate, which bases
it's recommendations on published literature. I hope this is helpful to you.





Dietary restrictions - It has also been suggested that affected individuals
should avoid ingestion of fava beans, also referred to as "broad beans,"
which can cause hemolysis in some but not all affected individuals [97
sphate-dehydrogenase-deficiency/abstract/97> ]. However, unlike certain
medications that induce hemolysis in all individuals with G6PD deficiency,
sensitivity to the fava bean is more variable.

The G6PD variant most commonly implicated in favism is G6PD Mediterranean
and G6PD Canton. Thus, favism occurs most often in people from Italy,
Greece, North Africa, the Middle East, and Asia [5
sphate-dehydrogenase-deficiency/abstract/5> ]. Africans and
African-Americans with G6PD deficiency are much less susceptible, although
there are very rare cases of favism associated with the African variant,
G6PD A- [98
sphate-dehydrogenase-deficiency/abstract/98> ]. In addition, the response to
the bean by the same individual at different times may not be consistent [99
sphate-dehydrogenase-deficiency/abstract/99> ]. Other genetic factors,
perhaps related to the hepatic metabolism of potentially oxidant compounds
within the fava bean, may play a role in determining the severity of the
reaction [99-101
sphate-dehydrogenase-deficiency/abstract/99-101> ]. For reasons that are
unknown, favism occurs mostly in children [102
sphate-dehydrogenase-deficiency/abstract/102> ].

Favism most often results from the ingestion of fresh (rather than
preserved) fava beans (picture 2
E%2F7111&search=g6pd+deficiency&rank=1%7E150&source=see_link> ).
Consequently, the peak seasonal incidence of favism in Mediterranean regions
coincides with harvesting of the bean during April and May [99
sphate-dehydrogenase-deficiency/abstract/99> ]. However, equally severe
hemolysis can occur after consuming fried fava beans, a popular Chinese
snack (picture 2
E%2F7111&search=g6pd+deficiency&rank=1%7E150&source=see_link> ). Favism also
has been reported in nursing infants whose mothers have eaten fava beans.

A question that often comes up relates to the safety of falafel, a common
Middle Eastern food. The answer depends on the ingredients. Egyptian falafel
is made from fava beans, whereas falafel made elsewhere in the world is
usually made from chick peas, which are considered safe for people with G6PD
deficiency. However, in some areas, falafel is made from a mixture of fava
beans and chick peas. The easiest response to the question is that
G6PD-deficient individuals should not consume anything with fava beans.
However, since not everyone with G6PD deficiency, particularly adults, is
sensitive to fava beans, we advise patients to use cautious observation.

Favism can also occur following ingestion of bitter melon. Also, several
other foods such as blueberries are listed on the internet as potentially
associated with hemolysis, although the direct relationship is not clear. In
our practice we do not advise dietary restrictions; however, for any
questionable food we emphasize to our patients and their families to be
observant of any changes suggestive of increased hemolysis. Patients are
encouraged to call their physician if any changes are noted.





From: < <>
> on behalf of " <> "
< <> >
Reply-To: " <> "
< <> >
Date: Friday, February 2, 2018 at 1:25 PM
To: " <> "
< <> >
Subject: [Favismlist] G6pd question


Hi, my name is Helene Warburg. We live in Israel and we have a 20 year old
daughter who recently came out positive for missing the G6PD enzyme and came
out that she has a level of 4.8 (on a scale where 7 to 14 is normal G6PD


My father in law was tested and came out positive. He was from German
descent, which is uncommon from what I understand. His level was 0.2


My American born mother in law we assume had it b/c my husband has G6PD. She
is of Polish descent. 


My American born husband has G6PD and has a level of 0.4 My sister in law
also has it - her level is 0.7.


My niece has it and my niece's son has it. We are having the rest of the
family tested now. 


The reason we even tested for this - is b/c my daughter had a VERY bad case
of pneumonia about 2 1/2 years ago. She was hospitalized for 9 days. She
went down from 43 kilos (94.6 lbs) to 38 kilos (83.6 lbs). She is 5'3" and
it was frightening. She was extremely weak. Prior to this bout of pneumonia
she was experiencing heart palpitations and and nausea for years - I always
attributed it to the assumption that she had food sensitivities. As a baby,
we assumed she was "allergic"/ sensitive to soy, milk products, gluten and
many other foods. 


Very recently she became very sick again with a bad virus  - then, while in
a weakened state, she suffered from 3 impacted wisdom teeth, she became very
weak and went down to 38 kilos again. It was just then, that I realized that
maybe we should test her for G6PD., which we did and her levels showed at


We live in Israel and the past year she ate edamame beans almost every
single day as part of her daily diet. She also eats a lot of falafel and
humous.  She was using soy based nutritional supplements "like Easy Drink"
to try and help her gain weight and become healthier. 


About 2 months ago when we discovered the G6PD she stopped eating soy,
edamame beans, all beans and lentils, red wine, stopped using henna, string
beans, green teas etc...  She has gained back 4 kilos and is feeling better
but still underweight. She ALSO has stopped smoking cigarettes (which
contains Naphtholene, I assume) and all Ibuprofens which she used to take
monthly when she got her monthly cycle.


My question is - does she REALLY have to avoid ALL of those foods that I
just mentioned above? Are there OTHER foods that she should avoid besides
these things I mentioned. 


I would REALLY appreciate your input as I really do not know where to turn.
My doctor does not know that much about G6PD and he sent us to a dietician
who just told us to avoid fava beans and aspirin. 


Thank you so much,

Helene Warburg




Mrs. Hadassah Warburg

Ner Leelef Women, Program Coordinator





UT Southwestern 

Medical Center


The future of medicine, today.


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