Farmacia italiana online: acquisto cialis in Italia e Roma senza ricetta.
Contact: John Hathcock
, (202) 204-7662
VP, Scientific & International Affairs
Are vitamins and minerals safe for persons with G6PD deficiency?
Persons with genetically inadequate activity of the enzyme G6PD are very susceptible to adverse
effects after ingestion of specific oxidizing substances present in some food and drugs. In these
individuals, the most common sign of toxicity is hemolytic anemia. Specific food and drug
substances associated with these effects include fava beans, which contain the oxidants vicine
and covicine, many antimalarials, sulfonamide antibiotics and several other drugs. No questions
have been raised about the safety of most vitamin and minerals in supplements for G6PD
deficient persons, but some texts claim that a few vitamins, notably vitamins C and perhaps K,
should be avoided. This fact sheet reviews the scientific evidence behind those
Q: What is G6PD?
Glucose-6-phosphate dehydrogenase is an enzyme that uses metabolic reactions to provide
the reducing capacity to keep glutathione in its reduced form (GSH) and available for its
metabolic roles that include regeneration of vitamins C and E after they are oxidized while
performing their antioxidant functions.
Q: Why is G6PD activity important?
Reduced glutathione is essential for protecting red blood cell membranes, and other cell
structures and components against oxidation. Without this protection by GSH, the red cells are
easily ruptured (hemolyzed), resulting in hemolytic anemia.
Q: What is G6PD deficiency?
G6PD deficiency is the condition in which the activity of this enzyme is low enough that the
person becomes unusually susceptible to adverse effects by substances that have strong oxidizing
characteristics. These strong oxidants include fava beans (Italian broad beans) and several drugs,
especially the quinine-based antimalarials.
Q: Who has G6PD deficiency?
It is a genetically determined condition. The incidence is not known because overt signs and
symptoms generally occur only in persons subjected to high levels of oxidative stress.
Moreover, a large number of genetic variations occur that may compromise G6PD activity to
different degrees, so there are varying degrees of deficiency in this enzyme activity and
corresponding differences in susceptibility to adverse effects by fava beans and oxidizing drugs.
Q: What are the practical consequences of G6PD deficiency?
Consumption of substances with strong oxidizing capacity by a person with low activity of
G6PD can result in hemolytic anemia in adults. The primary consequence is the anemia, an
insufficient capacity of the blood to bring oxygen to the tissues and carry away carbon dioxide.
The plasma of a person with hemolytic anemia may be colored pink or red by the hemoglobin
released by the rupture of red blood cells. Neonatal jaundice can occur in newborn infants with
severe G6PD deficiency.
CRN Fact Sheet, continued: Are vitamins and minerals safe for persons with G6PD deficiency?
Q: How is G6PD deficiency managed?
Persons known to be G6PD deficient are prohibited from taking certain drugs or eating fava
beans. If a severe episode of hemolytic anemia occurs, treatment may include blood transfusion
or nasal oxygen.
Q: Are vitamins and minerals safe for persons with G6PD deficiency?
Definitely yes, if their potency is within the safety guidelines for healthy persons. Some
textbooks and websites include lists of substances that G6PD deficient persons should avoid.
These often include not only oxidizing drugs but frequently include vitamin C and occasionally
vitamin K. In contrast, vitamin E is listed as protective. There is no clinical or other evidence
that ingestion of vitamin and mineral supplements, when used as directed, are associated with
adverse effects in individuals with G6PD deficiency.
The texts and websites that mention this possible effect often assert that vitamin C
can cause problems for G6PD deficient persons when consumed “in high doses.” Search of the
medical and scientific literature finds that vitamin C may cause red blood cell rupture
(erythrocyte hemolysis) in G6PD deficient adults after massive intravenous infusions (40 to 100
grams within a few hours, or in extremely large oral doses. There are no reports of this
hemolysis problem when oral intake by G6PD deficient persons is less than 6 grams per day in
G6PD deficient adults or in healthy adults at any dose. There is a single report of hemolysis after
a 1.5 gram intake by a 10 year old child who was G6PD deficient. By comparison, maximum
daily supplement intake by adults that is without recognized side effects is 2 grams (2,000 mg) in
healthy adults (www.crnusa.org/safety). For a 10 year old healthy child, the Food and Nutrition
Board identifies the vitamin C Tolerable Upper Intake Level (UL) as 1,200 mg of total daily
intake (http://www.nap.edu/openbook/0309069351/html/index.html), an amount expected to be
without any side effects. Thus, there is no known risk from vitamin C supplementation for
persons with G6PD deficiency if the intake is within the safety guidelines for healthy persons.
Search of the medical and scientific literature reveals a problem for G6PD deficient
adults only when given very large doses of vitamin K in a water-soluble form (vitamin K3, one
of the menadione salts). Large doses of water-soluble vitamin K have been tried (ineffectively)
in attempts to control the hemorrhage sometimes seen because of hemolysis in G6PD deficiency.
In either healthy or G6PD deficient adults, there are no reports of hemolysis or other toxic effects
from vitamin K as vitamin K1 (phylloquinone/ phytonadione, the form in conventional foods and
vitamin and mineral supplements) at any dose.
In contrast to the exaggerated or unfounded concerns about possible adverse effects
of vitamins C and K supplements in G6PD deficient persons, there are several convincing reports
that vitamin E in oral doses of 400 to 800 IU reduces, but may not completely eliminate, the
tendency of red cell to hemolyze in G6PD deficient persons. Thus, vitamin E is somewhat
protective in this condition.
Vitamin and mineral supplements are safe for G6PD deficient persons.
• There is no substantiation for concerns about vitamin C in normal or high doses (within
the general safety guidelines) for G6PD deficient persons.
• There is no known reason for concern about the usual supplemental forms of vitamin K
• There is substantial evidence that vitamin E supplements of 400 to 800 IU may be
somewhat helpful for those with G6PD deficiency.
Ira L. Flax, M.D., MACG • ernst r. dorsch, M.D., FACG robert a. herman, M.D., FACG • p. martin mauk, M.D., FACG COLE T. THOMSON, M.D., PH.D., PLLC • KATHERINE NGUYEN, M.D. Hashim M. Khandwalla, M.D. • PAT WALZEL, PA-C General Information for Your Procedure Restrictions the day of the procedure: 1. A responsible adult must take you home. Driving yourself, taking the bus,
LEAVING CERTIFICATE BIOLOGY HIGHER LEVEL EXAM PAPER SOLUTIONS Sample Paper 4 Section A Question 1 a) D: Zone of Differentiation/C: Zone of Elongation/A: Root Cap/B: Meristem 4(1)New Tissues: Zone of Differentiation/Mitosis: Meristem/Growth Regulators: Zone ofElongation/Absorbtion of water: Zone of Differentiation 4(1)(i) A: Vascular bundle/B: Air Spaces/C: Guard Cells/D: Stoma 4(1).