When it comes to adoring the creamy chickpea dip, hummus, Adam Alhajji is a culinary stereotype. Born in Saudi Arabia, the 45-year-old Adelaide resident loves devouring the traditional spread that’s central to his family’s treasured Middle Eastern cuisine.
The problem is that hummus doesn’t love Alhajji the same way back.
For years, Alhajji used to experience unexplained episodes of extreme lethargy and joint pain, and feel short of breath and dizzy – all the while not knowing that eating foods like hummus was making him very sick.
“In 2015, my wife and I trialled a vegetarian diet,” Alhajji recalls. “We were eating hummus and falafels as our main source of protein instead of meat. At the time, I felt like I was 79 years old and very tired. By two o'clock in the afternoon, I just wanted to have a nap. But these triggers were mercy in disguise.”
Inspired by his dietitian wife Huda AlSultan, Alhajji went to see a doctor to explore whether or not he had G6PD deficiency that ran in his family. Shortly after, he was diagnosed with the genetic disorder.
“To be honest, the diagnosis was not a surprise to me because there are members of my family who have G6PD deficiency – including my sister and some of my nephews,” Alhajji says. “But the diagnosis did give me an answer to my health problem.”
What is G6PD?
G6PD deficiency or favism occurs when the body doesn't have enough of an enzyme called glucose-6-phosphate dehydrogenase (or G6PD), which helps red blood cells to work. In affected individuals, the enzyme defect causes red blood cells to break down prematurely.
The most common medical problem associated with the condition is hemolytic anemia, which Alhajji lives with. According to Genetics Home Reference, it occurs when red blood cells are destroyed faster than the body can replace them. Symptoms include paleness, jaundice, fatigue, shortness of breath, and a rapid heart rate.
AlSultan, an Accredited Practising Dietitian, explains the condition is triggered by the consumption of fava beans, meaning all people with G6PD are unable to eat the food product. However, some individuals have more severe forms of G6PD and may experience additional food triggers.
"By two o'clock in the afternoon, I just wanted to have a nap. But these triggers were mercy in disguise.”
"International guidelines recommend all people with G6PD avoid eating fava beans," AlSultan tells SBS. "In practice, some people with the condition have also reacted to other legumes like chickpeas and need to avoid eating them to." She says fava beans and chickpeas are both from the same plant family, Fabaceae - hence the link.
"But this is not true for all people with G6PD. The condition ranges in severity."
Alhajji is one of the more rare cases and can not eat either fava beans, chickpeas or peanuts.
An Egyptian study published in 2018 cites that diet was the most common factor for hemolysis in patients with G6PD: over 80 per cent. Falafel was one of the most common food causes while chickpeas accounted for over 10 per cent of cases.
What does G6PD feel like?
Alhajji misses eating some of the most iconic dishes of his culture. “It's challenging to suddenly stop eating the food I love,” he tells SBS. “But if I eat chickpeas or other legumes, accumulatively, it will affect me and I will really feel it. I will feel tired and pain in my joints, usually at night. By the end of the day, my body would be so achy.
However, Alhajji acknowledges that some members of his family are affected by the disease in more extreme ways than he. "My younger sister has G6PD worse than me. The minute she eats hummus she feels pain straight away…She can't walk. She will have to take pain relief and need a hot bath to make her body come back to normal.”
G6PD may also be triggered by the consumption of bacterial or viral infections or certain drugs (like antibiotics). The condition is more common in males than females. Researchers believe people with G6PD may also be partially protected against malaria.
G6PD prevalence across cultures
Although the condition is quite rare in people of Anglo-Saxon descent living in Australia, G6PD is much more prevalent in the Middle East, Africa, and parts of the Mediterranean and Asia.
“It’s not a common condition in Australia,” confirms AlSultan. “When I came here, nobody knew about it – not even the doctors. They needed to look for what type of blood test they needed to do first, as they had not heard about it before.
“However, back in the Middle East, it is more common. If you say, ‘I have G6PD’ people will know what it is and that you don’t eat chickpeas or fava beans.”
"If you say, ‘I have G6PD’ people will know what it is and that you don’t eat chickpeas or fava beans.”
Studies report G6PD deficiency in Africa affects around 20 per cent of the population. In the Mediterranean, its prevalence is between four to 30 per cent and in Southeast Asia, it's 10-20 percent. According to a peer-reviewed 2020 study, the prevalence of G6PD in Saudia Arabia is about five per cent in all age groups, and between 15 to 30 per cent of newborns screened in two regions within the country over one year.
AlSultan tells SBS she uses her dietary and cooking knowledge to work around her husband’s condition when feeding the family traditional foods. “It is challenging,” AlSultan says. “But can you get creative in using substitutes when cooking.”
She says the trick is to look for low-carb recipes, which typically replace legumes with an alternative.
“Adam can’t eat hummus. So I make food that tastes like hummus with walnuts, for example. I blend it with other things to make it creamy. Of course, it’s not the same as hummus but I make it for him to have the experience of eating something similar.”
"If you do have it, you will have to give up some foods but –overall – it will improve your quality of life.”
These days, Alhajji tells SBS, although he still longs for his beloved hummus, he is happy with the alternatives his wife makes for him, purely because it’s improving his health.
“Even if fava beans or chickpeas are a big part of your culture’s cuisine, if you have this condition and eat these trigger foods, you are really compromising your quality of life,” Alhajji says. “So although it was hard to change my diet, it was worth it.
Alhajji encourages people who exhibit unexplained symptoms and are of a cultural background that has a higher prevalence of G6PD, to consult a medical professional for advice.
“I suggest that anyone who has symptoms of G6PD, see their doctor and ask for a blood test. If you do have it, you will have to give up some foods but –overall – it will improve your quality of life.”
If you are experiencing symptoms or feeling unwell, consult a medical practitioner for professional advice.