Every region and culture has its own unique cuisine. Falafel is eaten throughout much of the Middle East, but across Israel’s southern border, a different recipe for this popular food recently led to two separate medical emergencies.
The G6PD enzyme protects red blood cells from oxidative damage. In people with G6PD deficiency, certain triggers, including fava beans (also known as broad beans)—the main ingredient in Egyptian falafel known as ta’ameya—can cause hemolysis, the rapid breakdown of red blood cells. This can lead to severe anemia, jaundice, and dark urine.
Within 10 days of returning from family vacations in Egypt, two young boys arrived at Rambam Health Care Campus (Rambam) with acute hemolysis and low hemoglobin levels. Both came from families with a history of G6PD deficiency, sometimes referred to as “fava bean sensitivity,” but neither family realized that, unlike Israeli falafel, which is typically made from chickpeas, Egyptian falafel is made primarily from fava beans.
The first of the boys to be treated was a 12-year-old boy with jaundice, dark urine, and a significant drop in hemoglobin. Although the family had a history of G6PD deficiency, they did not know whether the boy himself had the deficiency.
After looking at the child’s history, the treating physician, Dr. Raizy Gruda-Sussman from the Joan & Sanford Weill Division of Pediatric Hematology-Oncology and Bone Marrow Transplantation, began investigating the possible cause. “We investigated every possibility, and then I asked him what he had eaten,” adds Gruda-Sussman. The family was adamant that he had not eaten fava beans during the trip, but said they had eaten falafel.
Gruda-Sussman did a quick check using ChatGPT and learned that Egyptian falafel is made from fava beans rather than the chickpeas typically used in Israeli falafel. “The family simply didn’t know,” she says.
The medical team carefully monitored the boy as his condition improved. A few days later, he was well enough to go home.
Just days later, an eight-year-old boy arrived at Rambam with similar, potentially dangerous symptoms.
“The family knew their son was sensitive to fava beans and carefully avoided exposing him to them,” says Gruda-Sussman. “However, they, too, were unaware that the ta’ameya they ate in Egypt was made from fava beans.” The boy required a blood transfusion.
His two-year-old brother had also eaten a small amount of ta’ameya and presented with a lower-than-normal hemoglobin level. However, since he had eaten a relatively small amount, he did not require hospitalization. The reaction to fava beans can be particularly significant in young children with G6PD deficiency. In more severe cases, the medical literature describes more serious complications associated with significant hemolysis, although most episodes resolve with appropriate treatment.
“It is surprising to treat two cases like these within such a short period,” notes Gruda-Sussman. “It is important to know what our food contains, particularly when there is a known sensitivity that can put you at risk.” She emphasizes the importance of checking ingredients, particularly when traveling, as familiar foods may be prepared quite differently from one country to another.
