The man was well until his wife baked him a “healthy recipe” from the NYTimes “Healthy recipe section: Fava bean and artichoke stew.

He soon became pale and jaundiced, and it took awhile for the ER doc to figure out why the man was sick. He had an acute hemolytic crisis, where his red blood cells burst, leaving him anemic, and soon he became jaundiced as the liver attempted to remove all the lose Hemoglobin from his system, and then his kidneys shut down…

The cause? A case of “Favism”: the man suffered from G6PD deficiency, a common blood problem that can lead to the blood cells bursting if you take certain common medicines, including some anti-malaria medicines, Sulfa drugs, Furadantin, some pain killers or…eat fava beans.

That is why this problem is often called “Favism”.

Indeed, the problem with fava beans had been noticed as far back as the days of Pythgoras, whose followers avoided the beans and even the pollen from the flowering plants, which sounds like superstition except that several of the articles mention the pollen problem. Reportedly the beans contain two problem chemicals:

The compounds vicine and isouramil, abundant in fava beans, are hypothesized to be the causative agents of the hemolytic response (Beutler, 1994).

The hemolysis is usually mild, and often discovered when you do a workup why a person is anemic.

Acute hemolytic crises can be dangerous (theoretically you could die if enough hemoglobin is released that it clogs up the kidneys and causes renal failure) and can also be caused by infection.

Most cases in the US are in blacks, but others who get it include Italians and Arabs. (there is also an Asian version of the disease).

So why do so many from the Mediterranean basin have the disease?

Check the map:


Map source.

These are areas where Malaria is common. If you have G6PD deficiency, you have some immunity to malaria.

Several other blood problems, including sickle cell anemia trait and some Thalassemia varients also are thought to give the person some resistance to malaria.

Factoid of the day: It might not have been lazyness and immorality that caused the fall of Rome, but the fact that malaria was introduced into the local swamps. And during previous historical periods that were warmer than now, malaria infected folks in much of the US and even Great Britain.

Another interesting fact: Malaria might be the reason that the problem of G6PD affects so many Africans (and their American descendants). The “lighter” areas of the G6PD map tends to be in countries with high altitude (e.g. Zimbabwe) or in areas of desert (e.g. Sudan).

So what do you do? If you are from certain areas or ethnic groups, you might want your doc to do a simple lab test for the problem.

Since fava beans are a good source of nutrition, some scientists are trying to figure out a way to produce beans without the chemicals that induce hemolysis, or by finding a “heirloom” variety which doesn’t cause the problem. However, such things are not yet being sold in the market.

So for now, if you are into the “Mediterranean” diet, just check where your ancestors came from, and get a blood test if they were from a high risk area.

Then Enjoy.

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Nancy Reyes is a retired physician in the rural Philippines. She blogs at Finest Kind Clinic and Fishmarket.

List of medicine can be found HERE.

More information on favism HERE.

For the third day in a row, the NYTimes Health articles included a healthy recipe that included fava beans.

Hello: Earth To NYTimes. Fava beans are nutritious, but you need to add a “caution” to your article.

And yes, this is not a “real” case: the only severe case I treated was a Mexican American man who developed jaundice and anemia after treating him with antibiotics.

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