Friday, 25 November 2011

G6PD aka Favism aka What do you mean he can't eat Ful (mashed beans)

I'm about to get scientific on all your asses right now so please bear with me.

There's a disorder out there called G6PD deficiency. Now G6PD is an enzyme called Glucose 6 Phosphate Dehydrogenase. It's an enzyme that protects the Red Blood Cells against oxidative damage. Now you might not know what oxidative damage means but all you need to know is that there are certain food items and medications that have molecules within them that can essentially destroy a red blood cell. G6PD is an enzyme that protects the red blood cell from this destruction.

The deficiency is pretty common especially here in Egypt, and it can be quite disastrous for the parents. Why is that you might ask? 

Well, remember when I said certain food items. By certain food items I mean Ful (

Looks appetizing no?

Ful is the commonest and cheapest dish prepared here in Egypt. It's basically mashed beans along with some olive oil and garnish. Suffice to say, many people of a lower socioeconomic class have designated Ful to be their prime nourishment throughout their life. It's cheap and it's satisfies the hunger more so than any other meal I've heard of. 

Having a deficiency in G6PD means you cannot eat Ful, forever.

If a person with a deficiency eats the beans, his or her red blood cells start getting destroyed (hemolysis) and the person presents with a case of acute severe anemia that cannot be corrected except with a blood transfusion. The destruction can be so severe that it can cause death in some cases. 

There is no cure or anything like that. The only cure is to stay the fuck away from all food items, including Ful, that may induce hemolysis.

Now as far as enzyme deficiencies go, this one is awesome. Most enzyme deficiencies are fatal and severely affect a person's lifespan because they're involved in vital functions of the human body. G6PD is just a 'protective' enzyme and so all it does is protect the cells. So, whenever a kid comes with this condition I usually tell the parents that it could've been alot worse.

Problem is, parents don't quite see how it could be alot worse. 

As I said, people of a lower socioeconomic level depend on Ful for sustenance. They can have it for breakfast, lunch and/or dinner. And in a country where more than 50% of Egyptians are on the poverty line, they try to be as economically wary as possible. 

To them, it's a death sentence. Reactions I've had from parents who were told their kids had the deficiency have ranged from sheer disbelief to just mental breakdowns and tears. I remember laughing a little on the inside when a certain family just broke down into tears about the subject. I thought they were being dramatic. After all, they came to us in the ER and there were kids dying everywhere, so just needing a blood transfusion and staying away from the stuff, to me, was a win. After going back home and talking to my friends about it, we realised they were crying because they literally had no idea where or how they were going to get enough money to feed their kid something that doesn't contain beans. 

We've had parents come in over and over again, because their answer was "We have to feed him something! He's going to die anyways if he doesn't eat, so we get him to eat the Ful then take him to the hospital for a blood transfusion." 

These are parents who are willing to take the risk of their child dying because they can't substitute Ful with anything else.  

Fucking crazy.

All in all, it's a sad disorder to have if you're living here in Egypt. Ful has seeped its way into culture even and many (myself included) are not considered full blown Egyptian if they don't eat Ful at least daily. 

I'll end this post on the funniest line I've heard from a patient's dad when I told him his son couldn't eat Ful forever, if only to document the mindset and to alleviate the sad tone of the post.

"Is this some sort of conspiracy? Is there going to be a Ful shortage so you're being forced to tell me that my son can't eat it? No, its impossible! God would not do this to the Egyptians. He can't! He knows how much we need Ful!"

It's funny, but also sort of sad.


  1. It's an expensive disorder indeed. Imagine having your only sources of protein basically be meat and chicken in a country like Egypt. You know what? It does sound like a conspiracy!

  2. My son was diagnosed with G6PD deficiency last year while we were living in the Middle East -- we had been visiting relatives in Egypt before returning to a neighboring country where we lived at the time.
    At first we thought he just had a bug, a flu, virus of some sort, but when we recognized the jaundice and various other symptoms we took him to hospital immediately where he received blood transfusions and a short hospital stay.
    Not only did make ful for breakfast during our last few days in Cairo, I also gave my poor son some medication which I'd bought over the counter for my children who were all runny nosed and set to catch a cold. I believe the ingredients of the medicine were also a contributing factor. A few days of ful, koshari, medication and so on proved detrimental to his health, but on the plus side, we are now in a position to stay away from it, forever!
    Our holidays to Egypt will require strict supervision of what is being consumed.

    My sons's specialist said don't be confused when the Arabs tells you to stay away from all beans, lentils etc... he said, just stay away from the fava beans.
    I'd like more information on this, your thoughts? To be on the safe side I'm keeping him as far as possible from those things mentioned on the G6PD website.

    Thanks -- will be following your blog with interest.