Management of Athletes With G6PD Deficiency: Does Missing an Enzyme Mean Missing More Games?

Abstract

Context: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is likely the most prevalent enzyme deficiency on the planet, with an estimated 4.9% of people, or approximately 330 million individuals, across the globe affected by the disease. In the United States, 4% to 7% of the population is likely affected, but each year our nation's major sport leagues become more international. It is important for medical professionals who treat athletes to understand how this genetic condition can affect the athletes we are working with, especially because exercise in itself results in oxidative stress.

Evidence acquisition: PubMed was searched for relevant articles published from 1980 to 2018. The search terms G6PD, athletes, military, and sports were used.

Study design: Clinical review.

Level of evidence: Level 4.

Results: Though some case reports suggest a potential impact on athlete safety and performance, controlled studies demonstrate limited impact of exercise on oxidative stress in G6PD-deficient individuals. The care of athletes with G6PD deficiency does not drastically differ from the care of athletes without this condition. Most of the medications and supplements that are regularly given to athletes should not negatively affect their health.

Conclusion: Although the care of athletes with G6PD deficiency is for the most part no different from the care of other athletes, there are certain situations (visiting areas where malaria is endemic) and medications for which it is important to recognize how your management should change. G6PD deficiency is not regularly screened for but could be considered if an athlete has known sickle cell disease or when traveling to areas where malaria is prevalent. Expanding our knowledge of G6PD deficiency will allow for better care of athletes.

Keywords: G6PD deficiency; athlete; international; medication safety; supplements.

Figure 1.

G6PD pathways. The top portion (A) represents the reaction pathway that protects the red blood cell (RBC) in individuals without an enzyme deficiency. The bottom portion (B) represents the pathway in individuals with glucose-6-phosphate dehydrogenase deficiency, resulting in increased RBC lysis. In the figure, a blue box indicates an oxidized component, yellow indicates a reduced component, and green represents an enzyme. NADP+, nicotinamide adenine dinucleotide phosphate; NADPH, reduced form of NADP+.