Nutrition

Nutrition Tips for People with Bleeding Disorders

Following a diet consistent with US Dietary Guidelines is recommended to promote optimal health for the US population, including people with bleeding disorders1. These guidelines are also important for prevention of age-related health outcomes recognized to be priorities in the bleeding disorder population including: maintaining a healthy weight, thereby reducing risk of heart disease, high cholesterol, Type II diabetes; and prevention of osteoporosis2. Maintenance of adequate iron stores is also essential for health, and requires special attention for people with ongoing blood loss.

US Dietary Guidelines for Optimal Health:

  1. Balance calories with physical activity to manage weight.
  2. Consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low fat dairy products, and seafood.
  3. Consume fewer foods with sodium (salt), saturated fats, trans-fats, cholesterol, added sugars and refined grains.

Recommendations for People with Bleeding Disorders:

  1. To promote long term bone health, be sure to get enough vitamin D and calcium every day from your diet and supplements3 (See Table 1: Calcium and Vitamin D Guidelines for Children and Adults with Hemophilia).
  2. Maintain a healthy weight to reduce risk for joint disease associated with bleeding disorders. Maintaining a healthy weight also reduces risk for chronic conditions such as diabetes and heart disease (See Table 2: Body Mass Index (BMI) Guidelines for Children and Adults1).
  3. Iron is essential for health. People with bleeding disorders have increased need for iron if experiencing ongoing blood loss. Iron needs depend upon age and gender. More iron is needed at times of rapid growth such as pregnancy, early childhood and adolescence. Women 14-18 years old need 15 mg of iron/day, women 19-50 need 18 mg, and pregnant women need 27 mg (See Table 3: Choosing Iron Rich Foods4).
  4. Fish and fish oil supplements. Large doses of omega-3 fatty acids (DHA and EPA) from fish and fish oil supplements may interfere with blood clotting. People who have a bleeding disorder should check with their provider to determine a safe dose.

Take control of your food supply to help achieve the diet you want. We live in a world that makes it challenging to choose a healthy diet. We have food companies, TV advertising, and often a food supply that is not focused on health. It can be hard as an individual to navigate this food environment. But you have control over the kinds of foods that you bring into your house, and the kinds of foods you may eat out. Include more fruits and vegetables and whole grains in the foods you buy and prepare. Watch out for "portion distortion" of restaurant servings.

Table 1: Dietary Reference Intakes for Calcium and Vitamin D3

                                                     Vitamin DCalcium
Age Amount per day
Infant (0-6, 7-12 months) 400 IU 200, 260 milligrams
Child  (1-3, 4-8 years) 600 IU  700, 1000 milligrams
Adolescent (9-18 years) 600 IU 1300 milligrams
Adult (19-50 years) 600 IU 1000 milligrams

Table 2: Body Mass Index (BMI) Guidelines for Children and Adults1

Category  Children and adolescents (BMI for age Percentile range)  Adults (BMI) 
Underweight  Less than the 5th percentile  Less than 18.5 kg/m2 
Healthy weight  5th percentile to less than the 85th percentile  18.5 to 24.9 kg/m2 
Overweight  85th percentile to less than the 95th percentile  25.0 to 29.9 kg/m2 
Obese  Equal to or greater than the 95th percentile  30.0 kg/m2 or greater 

Table 3: Choosing Iron Rich Foods4

Whole grains and enriched breads and cereals are good sources of iron. Read the labels to choose the best sources of iron.
Iron in meat, fish and poultry is especially well absorbed. Dark meats have more iron than lighter meats.
Eggs, dried beans and nuts provide more iron than poultry.
Dark green leafy vegetables can make important contributions to your total iron intake. 
Fruits and vegetables are good sources of vitamin C, and help increase iron absorption from other foods. 
Iron is better absorbed when combined with foods rich in vitamin C, such as orange juice or tomatoes.
Milk, yogurt and cheese are good sources calcium, but provide little iron.
Tofu, breast milk and infant formulas are all good sources of iron.
Dairy products, calcium, antacids, foods high in fiber and foods high in caffeine interfere with iron absorption and should not be taken at the same time as iron supplements5.

References: 

1. US Dietary Guidelines for Americans, Dietary Guidelines for Americans, 2010, February 16, 2014.
2. World Federation of Hemophilia, Guidelines for Management of Hemophilia, 2012.
3. National Research Council. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.
4. Virginia Cooperative Extension. Iron: Build Strong Blood, May 2009, February 16, 2014.
5. Medline Plus, A service of the US National Library of Medicine, NIH. Taking Iron Supplements, March 14, 2014.