G6PD deficiency—Fava Bean Intolerance


Compiled by Reed Mangels, PhD, RD, FADA

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited condition in which people don’t produce enough of the G6PD enzyme which is involved in preventing red blood cells from bursting (aka hemolysis) when exposed to certain substances in the blood. This hemolysis leads to anemia, jaundice (yellowing of the skin), rapid heart rate, and shortness of breath.

As many as 400 million people worldwide have G6PD deficiency. It’s more common in males and people of African, Asian, Middle Eastern, or Mediterranean descent. One in ten African American males has G6PD deficiency (1).

The symptoms of G6PD deficiency commonly appear in infancy or childhood (2) and can be triggered by aspirin, NSAIDs, as well as some malaria medications, antibiotics, and infections. Fava beans are also known to trigger symptoms (1).

Usually, the symptoms go away once the cause is identified and the person stops taking the medicine, eating the food, or recovers from the infection. Rarely, kidney failure and even death can be caused by G6PD deficiency. There’s no treatment for G6PD deficiency other than avoiding the substances that trigger hemolysis.

People with G6PD deficiency are told not to eat fava beans which are thought to be a problem due to a high concentration of two compounds, vicine and covicine (3). Other beans don’t contain vicine and covicine.

A recent study from Egypt that examined the medical records of 1,000 people with G6PD deficiency looked at which foods were identified as precipitating a hemolytic crisis. It wasn’t clear how the triggering foods were identified, but the researchers considered the majority of cases involving food as being due to eating fava beans or falafel—which is sometimes made with fava beans.

In the minority of cases, other legumes—including, chickpeas, broad beans, green peas, black-eyed peas, and lentils—were associated with a hemolytic crisis (2). However, these results for other legumes directly contradict a recent review article on G6PD deficiency which said:

Another myth is that other beans [besides fava beans] can cause an attack…Persons with G6PD deficiency should be told not to eat fava beans. This is the correct advice, and it is more likely to encourage compliance than a recommendation to avoid all legumes. (3)

Further study is needed to determine whether any legumes other than fava beans can lead to a hemolytic crisis in people with G6PD deficiency. Infants and children with a family history of G6PD deficiency can have a blood test to see if they have this condition. If parents or guardians notice that their infant or child is displaying symptoms of G6PD deficiency, they should contact the child’s health care provider.

References

1. National Institutes of Health. Glucose-5-phosphate dehydrogenase deficiency. Medline Plus. 2016.

2. Hagag AAE, Badraia IM, Elfarargy MS, Abd Elmageed MM, Abo-Ali EA. Study of glucose-6-phosphate dehydrogenase deficiency: 5 years retrospective Egyptian study. Endocr Metab Immune Disord Drug Targets. 2017 Oct 3. [Epub ahead of print]

3. Luzzatto L, Arese P. Favism and glucose-6-phosphate dehydrogenase deficiency. N Engl J Med. 2018 Jan 4;378(1):60-71.

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