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+Nutrition and Sickle Cell Good nutrition is especially important for people with sickle cell disease. It helps promote health and prevent complications. Children with sickle cell disease need a diet that provides plenty of calories, protein, vitamins and minerals. Their bodies use more energy because they break down red blood cells faster than other children do. Higher energy needs make it common for affected children to be shorter and thinner than their peers. Kids with sickle cell disease can often catch up to their peers, if they meet their energy needs. High-calorie foods or extra snacks can be helpful, and that is why we’ve developed this cookbook. We want to help you meet the energy needs of a child with sickle cell disease by preparing appealing, calorie-dense meals and snacks. When the body has enough fuel, it will have an easier time replacing red blood cells. Meeting fluid needs is also important for children with sickle cell disease. It’s common for affected children to have problems with their kidneys and with fluid retention, so pushing fluids is often necessary. Extra fluid also helps prevent red blood cells from sticking, which can help with pain relief. It is important to know that when children with sickle cell disease are sick, they often lose fluids through vomiting, diarrhea, fever or reduced fluid intake, which can lead to dehydration. Fluid needs are also more intense during hot weather, when traveling, with lots of physical activity, and when a child has a fever. In early adulthood, alcohol consumption can also cause dehydration. Signs of dehydration include dark urine, dry mouth, difficulty or burning when urinating, and sunken eyes. It’s helpful for children with sickle cell disease to have extra water breaks to stay hydrated. It is also often helpful if the child carries a water bottle at school to sip on all day. If a note is required to carry a water bottle at school, please let us know. Vitamin and mineral supplements are usually recommended for children with sickle cell disease. Often, affected children must take folic acid supplements as ordered by their doctor. Folic acid helps to produce new cells. Other supplements may be recommended as well, based on the child’s needs. Please be sure to tell your doctor or nutritionist of any vitamin or mineral supplements your child is taking. Some supplements, such as those containing iron, can be a problem for children with sickle cell disease. For those with lactose intolerance (difficulty tolerating milk), lactose-free milk can be substituted for regular milk or Lactaid® pills can be taken with the recipes that contain milk to improve tolerance. Vitamin D and Sickle Cell Why is it important and where to find it? Why is it important? • Vitamin D is important for those with sickle cell disease because it can help decrease sickle cell pain days. • Vitamin D can help improve immunity. • Vitamin D is a vitamin that helps the body use calcium. Both calcium and Vitamin D are needed for strong bones. • Children with sickle cell disease are also at high risk for vitamin D deficiency. Where to find it? Good places to find vitamin D include most fortified foods like milk, cereal and orange juice. The body can make vitamin D from sunlight, but it is also important to prevent cancer by using sunscreen if you will be out in the sun for more than 15 minutes. Good food sources of Vitamin D include: • Salmon • Tuna • Orange juice • Dairy products • Mushrooms • Cheese • Cereals • Egg yolks NUTRITION AND SICKLE CELL VITAMIN D AND SICKLE CELL 3Eating Well With Sickle Cell 4 5 Eating Well With Sickle Cell Eating Well With Sickle Cell Micronutrients: Vitamins A, C, E and Zinc Why are they important and where to find them? Micronutrients are another word for vitamins. They help your body do many things such as making immune cells, growing and using energy. Vitamin A is helpful for eyesight. Vitamin C and E are important for the immune system, and zinc is needed for growth and healing. Children with sickle cell disease may need more vitamins than other kids without sickle cell disease. We are not sure exactly why, but this may be because the body is always trying to make red blood cells. Good places to find these vitamins include fortified foods, nuts, seeds, tomato products, orange and yellow fruits and vegetables and leafy vegetables. Good sources of micronutrients include: Our medical team feels that it may be helpful to add a multivitamin daily, but it will be important to choose the multivitamin that best meets the needs of those with sickle cell disease. The multivitamin should not have iron in it due to the possible need of those with sickle cell disease to receive planned or unplanned blood transfusions. Transfusions give extra iron to the body and can lead to too much iron in the blood. Because a multivitamin is not covered under insurance, and can be an extra cost with your other medical expenses, we understand if it doesn't fit in your budget. We suggest the following when looking for a multivitamin: • Continue folic acid depending on advice from your health care provider. • Children under 2 should use poly vi sol without iron, 1 ml. • Look for a multivitamin without iron that meets the nutrients listed below. • No vitamin is perfect and many vitamins may not meet the minimums for the recommendations below without exceeding the maximums. • Gummy vitamins can be more expensive. • Almonds • Canned tomatoes • Spinach • Sweet potatoes • Orange juice • Cereals • Eggs • Dairy products • Red peppers • Fortified grains and cereals • Legumes Folic Acid Basics What is it? Where to find it? Folate is a type of B vitamin that helps prevent anemia. Folic acid is also helpful in treating sickle cell disease because it helps to make and store red blood cells. Children with sickle cell disease have red blood cells that break down faster than an average person, and folic acid helps to replace red blood cells. Natural sources of folic acid include leafy green vegetables, fruits, dried beans and peas. Fortified (added folate) sources include breads, cereals, flours, corn meals, pastas, rice and other grain products. Keep these folate-rich foods in mind when making choices. Good sources of folate include: • Peanuts • Avocado • Broccoli • Romaine lettuce • Spinach • Strawberries • Papaya • Asparagus • Corn • Orange juice • Enriched or fortified products Vitamin A-IU Vitamin C-mg Vitamin D-IU Vitamin E-mg B12-mcg 2-8 years old— minimum 1,000 15 400 7 1 2-8 years old— maximum 5,000 600 5,000 100 20 9-18 years old— minimum 3,000 45 400 15 2 9-18 years old— maximum 6,000 1,000 5,000 100 30 MICRONUTRIENTS: VITAMINS A, C, E AND ZINC FOLIC ACID BASICS 6 7 Eating Well With Sickle Cell Eating Well With Sickle Cell How to Satisfy Picky Eaters Kids (and adults) have to try a food 10-15 times before we actually decide we like it. Try offering foods many times and cooked in different ways. For example, if you want your child to try carrots, try to offer them raw, steamed, grilled or sautéed. Don’t be discouraged if your child does not like a food on the first try, but keep trying! These tips might help: • Try different ways to serve fruits and vegetables like raw, sautéed, grilled, with dip. • Eat them yourself! Children are more likely to do what they see their family do, instead of what they are told to do. • Present a food 10-15 times. This is how long it takes someone to get used to a food and decide if they like it or not. • Get ready for the food to be refused. Often it will be refused several times before it’s accepted. • Consider making a reward system when a new food is tried. • When offering a new food, talk positively about it to other family members. We talk about how good ice cream is, but not always how delicious broccoli is. Tips for Easily Increasing Calories Helping children with sickle cell meet their high-energy needs can be tricky. It is important to know easy ways to help them get the calories they need without depending on “junk” food. There are high-calorie options available that are healthy. Here are a few tips to increase calories: • Eat more frequently! Try to get your kids to eat three meals a day and several snacks. Eating small meals several times a day usually works best. • Add calories to low-calorie, but nutritious foods by: – Adding oil when cooking vegetables or meat – Serving peanut butter with bananas, apples or celery – Using gravies and sauces – Adding nuts, beans, cheese, dried fruits, etc., to salads – Adding almonds or other nuts to cereal – Adding powdered milk to soups, sauces, casseroles and hot cereal • Choose high-calorie foods and snacks. Avocados, nuts, whole milk and milk products are high in calories. Try mixing it up! Add nuts to yogurt or have some hummus with vegetables or crackers for a snack. • Avoid empty calories. Instead of drinking sodas or sports drinks, get your kids to drink whole milk or juices. Whole milk contains protein, calcium, potassium, vitamin D and calories. • Supplement when necessary. If you are worried about your child’s growth, there are highcalorie supplements available. Supplements like PediaSure®, Ensure®, Boost®, or Carnation Breakfast Essentials® and SCANDISHAKE® are high in calories and protein. For children who are not meeting their nutritional needs through food alone, these supplements are an option. Before starting these, though, make sure to let your doctor or nutritionist know. HOW TO SATISFY PICKY EATERS TIPS FOR EASILY INCREASING CALORIES 8 9 Eating Well With Sickle Cell Eating Well With Sickle Cell IDEAS FOR REDUCING FOOD COSTS Ideas for Reducing Food Costs Grocery shopping can be a challenge when you are on a budget and looking to buy and make healthy, high-calorie foods. There are many ways to stretch your food dollar so that you can buy and make nutritious foods and use them for more than one meal. You will not only save money this way, but may find cooking to be much easier. Here are a few tips for eating well on a budget: • Check the sales flyer. Plan your meals and snacks for the week around what is on sale. Then make your shopping list and stick to it! • Include frozen, canned and dried forms of fruits and vegetables. They are all healthy and handy for quick-fix meals and snacks. • Buy in-season. Although most fresh fruits and vegetables are available year-round, many are less expensive when they are in-season. • When there are specials on fruits and vegetables, buy extra. They can be frozen, or you can prepare a dish to be frozen for a busy night’s dinner. • Avoid shopping at convenience or corner stores because their food is more expensive. Compare prices among grocery stores. • Shop at grocery stores that sell store brand foods. Look at the top and bottom shelves in the grocery store aisles for these items. The most expensive items are at eye-level on the shelves. • Never shop on an empty stomach! When you’re hungry, you’ll be more tempted to splurge. • Use caution with coupons. Coupons are usually for more expensive items. Do not buy junk food or something you normally wouldn’t buy just because you have a coupon. • Make sure the food you buy is fresh. Sometimes, foods are on sale because they are close to going bad. Always check the expiration and “use by” dates on milk, meats, dairy, bread, etc. • Buy in bulk only when it makes sense and check the unit price of the item. Are you a member of one or more of the discount and warehouse stores that sell groceries? Not all bulk items are bargains. Only buy something in bulk if it’s a food that your family eats often. Otherwise, it may spoil before you have a chance to use it. Try to buy only nonperishable foods in bulk (dried beans, grains and canned foods). • Make food from scratch. You pay more for the convenience of pre-made items. IDEAS FOR REDUCING FOOD COSTS • Prepare more so you have leftovers. Use them for lunch or dinner, freeze them, or create a new dish. • Use leftover vegetables in stir-fry dishes, soups, stews and for making veggie patties. • Replace half the meat. Substituting half the meat in a recipe with beans and/or vegetables will reduce fat and increase fiber. This also saves money. • Shop locally. Your local produce stand or farmer’s market can be a great source of healthy bargains. For the best deals, shop often and look for reduced produce or end-of-the-day specials. Farmer’s markets usually have dried fruits that are a great source of extra calories! • Grow your own. Start a garden in your backyard or a container garden on your patio. Enjoy homegrown fruits and vegetables all season long. • Buy apples, oranges, grapefruit, potatoes and onions by the bag. Do not buy by the piece — it is cheaper and will fill more lunch bags and cover more meals. • Avoid the temptation of buying bagged/ washed lettuce, cabbage and carrots. They cost more and you get less. • Use canned fish and chicken for sandwiches, enchiladas, casseroles and salads. Canned meats are usually less expensive. • Buy bigger boxes of food items instead of individual bags. Plan ahead if you need to have snacks on the run, and pack them in plastic bags and travel cups. • Beans are the cheapest, healthiest source of protein that you can buy, in addition to having a lot of fiber