Q: Could you talk a bit about your planned research?
A: Our team, which combines expert clinicians and scientists from UBC and BC Children’s Hospital, will be conducting a randomized clinical trial in which children with sickle cell disease are provided with high-dose folic acid (the current standard of care) and a placebo for 12-week time periods to determine circulating levels of folate and folate metabolites, and clinical outcomes during periods of supplementation and no supplementation.
Q: What is sickle cell disease? Does it affect certain populations?
A: Sickle cell disease is an inherited blood disorder that causes red blood cells to have an abnormal sickle shape, instead of a rounded shape. This can cause a host of health issues for individuals affected by the disease, ranging from anemia to blood vessel blockage (episodes of body pain, swelling). It mostly occurs in individuals of African and Middle Eastern descent. It is thought that sickle cell disease offers some protection from malarial infection, which is more common in those areas.
It is estimated that there are over 5000 individuals with sickle cell disease in Canada.
Q: What inspired this project?
In sickle cell disease, red blood cells have a reduced life span due to the cell’s abnormal shape. This increases the rate that red blood cells must be produced, and is thought to increase the amount of folate (a B vitamin required for the production of red blood cells) that an individual needs.
Most of the research that suggested individuals with sickle cell disease may have higher folate requirements was conducted in the 1970s and 1980s, before Canada introduced mandatory folic acid (synthetic folate) fortification of refined grains, and before the clinical adoption of medications that extend the life of red blood cells in sickle cell disease. The widespread clinical practice of prescribing 1-5 mg of folic acid per day to individuals with sickle cell disease, which can provide as much as six times the amount required by healthy individuals, has not been reassessed in the context of those medical and nutritional advancements.
Furthermore, controversy has arisen over the potential adverse effects of excessive folic acid intakes, calling this clinical practice into question.
Q; Are you using any innovative or unique approaches in your research?
A: This research is the first well-designed randomized clinical trial of its kind assessing the efficacy and potential harm of high-dose folic acid supplementation in children with sickle cell disease. It is also the first clinical trial in children with sickle cell disease to incorporate measurements of unmetabolized folic acid (folic acid that appears in blood circulation when enzymes which convert folic acid into a form our bodies can readily use are saturated) into the study design and assessment of folic acid supplementation.
Q: What impact do you hope your research will have?
A: We hope that the results of this research will inform clinicians as to whether high-dose folic acid supplementation is efficacious, safe, and warranted in children with sickle cell disease. We also hope that this research will be the first step in the future optimization of clinical nutrition care for individuals with this disease.
Brock Williams is a Registered Dietitian currently undergoing his doctoral training in Human Nutrition under the supervision of Dr. Crystal Karakochuk. Brock previously completed his graduate dietetic internship at the Hospital for Sick Children (SickKids) (2014), MSc in Human Nutrition at McGill University (2012), and his BSc at St. Francis Xavier University (2010). His primary research interests lie in infant/child health, micronutrients, and in optimizing clinical care and health outcomes of paediatric populations.
Learn more about the Karakochuk Research Group.