Dr Robert Bird, member of our Medical Advisory Board, has shared information about ITP patients being at an increased risk of blood clots and not just bleeding.
08
Jul
30
May
On 24 May 2025, just over two hours into Committee A at the 78th World Health Assembly, something remarkable happened. Member States officially adopted the first-ever global resolution on rare diseases. This moment represents a major milestone for more than 300 million people around the world living with a rare disease, including those affected by Immune Thrombocytopenia (ITP).
28
May
Right after the inevitable “Wait—what is ITP again?” one of the most heartfelt and frequent questions I hear from patients is: “Is there anything I can eat that might help?” It’s such a reasonable question—because when you’re living with something as uncertain as ITP, it makes sense to want to take back a bit of control. You want to do something that might make a difference.
I’ll be honest—there have been times when I’ve nodded thoughtfully and then offered the usual line: “Just keep taking your meds.” But please know, it’s not because your question isn’t valid, or because we don’t care. It’s because, right now, the science doesn’t always give us clear answers. That doesn’t mean we stop asking—it just means we tread carefully, together.
Written by by Dr Phil Choi
Here’s what we know – and what we’re still learning – about how diet and supplements may contribute to these goals.
Increasing Platelet Counts
Carica papaya leaf extract (CPLE)
CPLE has a long history of use in parts of the world dealing with Dengue fever. In lab models, it’s been shown to stimulate liver production of thrombopoietin (TPO) – the hormone that drives platelet production [1]. A few small case series suggest benefits in ITP patients using doses around 1000mg three times a day [2]. We still don’t have head-to-head studies comparing CPLE to established ITP treatments, but that could change in the near future.
Peanut skin extract (Procyanidin A1, or PS-1)
A traditional remedy in Chinese medicine, it appears to support platelet production in mice by activating the JAK2 pathway and scavenging free radicals [11]. But evidence in humans is scarce, and we lack consistent dosing or safety data.
Melatonin
Better known for sleep regulation, has protective effects on megakaryocytes (the cells that make platelets) in mice undergoing chemotherapy [9]. There are a few case reports of ITP patients seeing benefit at high doses (around 30mg daily) [10]. Of course, side effects like drowsiness can be problematic – especially for patients already dealing with fatigue.
All-trans retinoic acid (ATRA)
ATRA is a powerful form of vitamin A that supports bone marrow function and protects it from immune-mediated damage [3, 4]. In clinical trials, ATRA has shown benefit in combination with other treatments for both newly diagnosed and chronic ITP [5-7]. But the effective doses are about 800 times the usual daily intake of vitamin A [8], which makes this a pharmacological – not dietary – intervention.
Branched-chain amino acids (BCAAs)
BCAAs are popular among athletes. They activate mTOR signalling, which in mice has led to faster platelet recovery after chemotherapy [12]. However, to replicate that effect in humans, we’d be looking at around 30g of BCAA per day – roughly half of an adult’s total recommended protein intake. High BCAA diets have also been associated with increased thrombotic risk, so I wouldn’t recommend loading up on them without careful consideration.
Reducing Bleeding
When it comes to bleeding, platelet numbers matter—but so does how well your platelets function, the integrity of your blood vessels, and the status of your clotting factors.
- Vitamin C plays a crucial role in collagen formation, which supports the ability of platelets to form plugs at injury sites.
- Vitamin K is needed by the liver to produce clotting proteins.
On the flip side, there are some dietary items that can impair platelet function – at least in the lab. These include:
- Alcohol
- Garlic and onions
- Spices like turmeric, cumin, fenugreek, and tamarind
- Supplements like gingko biloba, ginseng, and fish oil
- Herbal products like St John’s Wort and chamomile [13, 14]
We don’t yet know how much of these substances you’d have to consume to cause actual bleeding issues in ITP patients. But if you’re experiencing unexplained bruising or bleeding, it’s worth reviewing what’s in your kitchen and supplement drawer.
Suppressing or Rebalancing the Immune System
Since ITP is autoimmune in nature, there’s interest in whether diet can reduce inflammation and modulate immune responses.
Anti-inflammatory diets
Diets such as the Mediterranean diet, are rich in omega-3s, antioxidants, vitamin C, and polyphenols. They’re low in red meat, processed foods, sugar, and trans fats. While they’ve been shown to reduce inflammatory markers in healthy people [15, 16], their effect on platelet counts in ITP remains unproven. Interestingly, omega-3s and polyphenols can impair platelet function in vitro [17], which raises the question: can something be both good for your immune system and bad for your bleeding risk?
Autoimmune Protocol
This diet is more intense. It starts with a full elimination of potential gut irritants (e.g., gluten, legumes, dairy, sugar, eggs, nightshades, alcohol, coffee, nuts), then reintroduces them one at a time. While there’s some evidence this approach can benefit patients with inflammatory bowel disease, no studies have examined its role in ITP.
Gut Biome
The gut microbiome is another frontier. ITP patients have been shown to have different microbiota profiles compared to healthy controls [18], and even different patterns based on how well they respond to treatment [19]. Still, aside from Helicobacter pylori, we haven’t identified microbiome-based therapies with proven benefits in ITP.
Managing Side Effects from ITP or the Treatments
Sometimes, the biggest challenge isn’t the ITP itself – it’s dealing with the side effects of treatment. Fortunately, there are several ways diet can help here too.
Fatigue
It’s one of the most reported symptoms of ITP. However, we also need to consider other causes, which can include thyroid disease, reduced fitness, poor sleep quality and insomnia, muscle weakness, iron deficiency, depression and anxiety. Serotonin is critical for nerve transmission, and low levels can affect mood, sleep and digestion.
Steroids
They’re notorious for insomnia, reflux, weight gain, and bone density loss. To manage these:
- Limit caffeine and consider melatonin for sleep.
- Avoid spicy and greasy foods to ease reflux.
- Cut back on sugary, calorie-dense foods to prevent weight gain.
- Focus on calcium and vitamin D-rich foods (e.g., dairy) to help protect bone density.
IVIg
It’s essential to stay hydrated when receiving IVIg, as this may help reduce the risk of headaches. Also, consider avoiding dehydrating drinks like caffeine and alcohol.
Iron deficiency
This is common in ITP, especially with ongoing blood loss. Iron + vitamin C supplementation can help, though constipation is a frequent side effect. Watch out for homeopathic iron products – many contain too little iron to be useful.
Intravenous iron is becoming a more accessible and well-tolerated option in clinical practice.
Other considerations
Some ITP patients also experience coeliac disease or thyroid dysfunction, both of which can contribute to fatigue, poor iron absorption, or abnormal blood counts. These should be considered if symptoms persist despite good platelet control.
Finally, a quick word on serotonin: 90% of the body’s serotonin is stored in platelets. When platelet counts are low, circulating serotonin may also be low, possibly contributing to poor mood, sleep disturbances, or gut issues. The body makes serotonin from tryptophan, found in foods like turkey, eggs, cheese, salmon, nuts, and seeds. Carbohydrates help get tryptophan into the brain [20]. While this hasn’t been studied in ITP specifically, it’s an interesting area for future research.
In Summary
There’s no perfect “ITP diet” – and no supplement or food is going to replace medical therapy. But that doesn’t mean nutrition doesn’t matter. Whether it’s about bleeding, fatigue, inflammation, or treatment side effects, there are things you can do to support your health and feel more in control.
That said, be cautious. A lot of the promising research we have is based on cell cultures or mice – not people. And what works in a lab doesn’t always translate into meaningful results in the clinic.
Still, I believe that empowering patients with information is one of the best things we can do. Ask questions. Be curious. And if you’re considering changes to your diet or supplement routine, please talk to your doctor – especially if you’re on treatment.
One more thing …
I have one patient who started drinking her own tea, which we tested and tracked her platelets. While there is little clinical evidence, it works for her, and I thought that I’d share it with you too. Regardless of it working for you, or not, it tastes pretty good, so why not give it a shot.
In Summary
There’s no perfect “ITP diet” – and no supplement or food is going to replace medical therapy. But that doesn’t mean nutrition doesn’t matter. Whether it’s about bleeding, fatigue, inflammation, or treatment side effects, there are things you can do to support your health and feel more in control.
That said, be cautious. A lot of the promising research we have is based on cell cultures or mice – not people. And what works in a lab doesn’t always translate into meaningful results in the clinic.
Still, I believe that empowering patients with information is one of the best things we can do. Ask questions. Be curious. And if you’re considering changes to your diet or supplement routine, please talk to your doctor – especially if you’re on treatment.
References
- Aziz, J., et al., Carica papaya induces in vitro thrombopoietic cytokines secretion by mesenchymal stem cells and haematopoietic cells. BMC Complementary and Alternative Medicine, 2015. 15(1): p. 215.
- Hampilos, K., et al., Effect Of Carica Papaya Leaf Extract On Platelet Count In Chronic Immune Thrombocytopenic Purpura: A Case Series. Integr Med (Encinitas), 2019. 18(5): p. 30-35.
- Zhu, X., et al., All-trans retinoic acid protects mesenchymal stem cells from immune thrombocytopenia by regulating the complement–interleukin-1β loop. Haematologica, 2019. 104(8): p. 1661.
- Feng, Q., et al., High‐dose dexamethasone or all‐trans‐retinoic acid restores the balance of macrophages towards M2 in immune thrombocytopenia. Journal of Thrombosis and Haemostasis, 2017. 15(9): p. 1845-1858.
- Huang, Q.S., et al., All-trans retinoic acid plus high-dose dexamethasone as first-line treatment for patients with newly diagnosed immune thrombocytopenia: a multicentre, open-label, randomised, controlled, phase 2 trial. Lancet Haematol, 2021. 8(10): p. e688-e699.
- Wu, Y.-J., et al., All-trans retinoic acid plus low-dose rituximab vs low-dose rituximab in corticosteroid-resistant or relapsed ITP. Blood, The Journal of the American Society of Hematology, 2022. 139(3): p. 333-342.
- Feng, F.E., et al., Oral all-trans retinoic acid plus danazol versus danazol as second-line treatment in adults with primary immune thrombocytopenia: a multicentre, randomised, open-label, phase 2 trial. Lancet Haematol, 2017. 4(10): p. e487-e496.
- Health, N.I.o. Vitamin A and Carotenoids. Fact Sheet for Health Professionals. 2025 10 March 2025 [cited 2025 11 April]; Available from: https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/.
- Yang, M., et al., Melatonin protects against apoptosis of megakaryocytic cells via its receptors and the AKT/mitochondrial/caspase pathway. Aging (Albany NY), 2020. 12(13): p. 13633-13646.
- Todisco, M. and N. Rossi, Melatonin for refractory idiopathic thrombocytopenic purpura: a report of 3 cases. Am J Ther, 2002. 9(6): p. 524-6.
- Wang, R., et al., Proanthocyanidin A1 promotes the production of platelets to ameliorate chemotherapy-induced thrombocytopenia through activating JAK2/STAT3 pathway. Phytomedicine, 2022. 95: p. 153880.
- Jiang, H., et al., Branched-chain amino acids promote thrombocytopoiesis by activating mTOR signaling. J Thromb Haemost, 2023. 21(11): p. 3224-3235.
- Vilahur, G. and L. Badimon, Antiplatelet properties of natural products. Vascul Pharmacol, 2013. 59(3-4): p. 67-75.
- Harrison, P., et al., Guidelines for the laboratory investigation of heritable disorders of platelet function. Br J Haematol, 2011. 155(1): p. 30-44.
- Goodnight, S.H., Jr., Effects of dietary fish oil and omega-3 fatty acids on platelets and blood vessels. Semin Thromb Hemost, 1988. 14(3): p. 285-9.
- Dryer-Beers, E.R., et al., Higher Dietary Polyphenol Intake Is Associated With Lower Blood Inflammatory Markers. The Journal of Nutrition, 2024. 154(8): p. 2470-2480.
- Singh, I., et al., The effects of polyphenols in olive leaves on platelet function. Nutr Metab Cardiovasc Dis, 2008. 18(2): p. 127-32.
- Sun, H., et al., A novel approach to immune thrombocytopenia intervention: modulating intestinal homeostasis. BMC Immunology, 2024. 25(1): p. 71.
- Rui, X., et al., Gut microbiota were altered with platelet count and red blood cell count in immune thrombocytopenia patients with different treatments. Front Cell Infect Microbiol, 2023. 13: p. 1168756.
- Spring, B., Recent research on the behavioral effects of tryptophan and carbohydrate. Nutr Health, 1984. 3(1-2): p. 55-67.
15
May
Just over a year ago, Cassy was diagnosed with the rare autoimmune bleeding disorder immune thrombocytopenia (ITP).
01
May
At ITP Australia and New Zealand, we are committed to providing patients, caregivers, and healthcare professionals with reliable and accessible information to help navigate life with Immune Thrombocytopenia (ITP). Our patient resources have been carefully developed to offer practical support, answer common questions, and empower individuals to make informed decisions about their care.
28
Apr
23
Apr
Receiving a diagnosis of immune thrombocytopenia (ITP) often comes with a flood of questions, one of the most pressing being, “Is ITP curable?” This article explores the complexities of ITP, current treatment options, and the ongoing search for a cure.
01
Apr
26
Mar
01
Mar
If you’ve been diagnosed with Immune Thrombocytopenia (ITP), you probably have many questions – about symptoms, treatments, remission, and what to expect in the long run.
You’re not alone! Patients often ask about the causes of ITP, whether it can be cured, how to manage fatigue, and if lifestyle changes can help. Understanding your condition is key to making informed decisions about your health.
We’ve compiled answers to some of the most frequently asked questions to help you feel more confident in managing ITP.
Immune Thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder characterised by a low platelet count resulting from platelet destruction and/or impaired platelet production.
Many of the treatments and therapies available for Immune Thrombocytopenia (ITP) can assist with stabilising platelet counts and reduce active bleeding.
Some of these therapies can induce remission from ITP, but only a minority will be cured with existing treatment. Improving cure rates for ITP is the goal of several current research trials.
It is estimated that the prevalence of ITP is 1 in every 10,000 people across Australia and New Zealand. ITP is a rare disease, which is defined as a disease frequency of <1 person in every 5,000 people.
There is no single test currently available to determine that a person has ITP as there are many causes for a low platelet count. The diagnosis includes a thorough personal and family medical history, physical examination and various blood tests to rule out other reasons for a low platelet count, including a blood film examination.
Platelets are produced in the bone marrow along with red and white blood cells. When released into the blood the cells circulate within the blood and bind together when they receive a signal indicating that there are damaged blood vessels. For example, when you get a cut the platelets bind to the injured site resulting in the first stages of a clot and then the bleeding stops.
The most common symptoms of Immune Thrombocytopenia can include spontaneous bleeding and bruising, prolonged bleeding, petechiae (skin rash of small red dots) bleeding gums, wet blood blisters in the mouth, heavy or abnormal menstruation, nose bleeds, fatigue, brain fog, anxiety and other mental health concerns.
The treatment for ITP is different in each country/region, however in Australia and New Zealand, first line treatments include corticosteroids and IVIg. If these treatments fail to work, then second line treatments include TPORAs, Rituximab, combination therapies and in some cases, Splenectomy. Review the current treatment consensus guidelines for more information.
While there’s no proven way to naturally increase platelets in ITP, maintaining a healthy lifestyle and diet may support overall health. Always consult your doctor for medical advice.
The exact cause is unknown, but it’s believed to be an autoimmune reaction in which the body mistakenly attacks its own platelets or has impaired platelet production.
Fatigue can be a symptom of ITP, possibly due to the body’s ongoing immune response or as a side effect of treatments. Fatigue was reported in the I-WISh study, conducted in 14 countries and completed by 1400 ITP adult patients and 480 healthcare professionals.
Generally, people who have had, or currently have Immune Thrombocytopenia are not eligible to donate blood.
The first description of ITP dates back to 1808 when Robert Willan where ITP was described as “Purpura haemorhagica occurs at every period of life, and chiefly affects persons of a weak and delicate habit. Women and boys appear to be most liable to it: in the latter, the haemorrhage usually takes place from the nose”.
ITP was reported to be due to “a sedentary mode of life, poor diet, impure air, and anxiety of mind, are the usual exciting causes of this disease”.
And to treat the disease “we recommend moderate exercise in the open air, a generous diet and the free use of wine …”
Willan’s observations and treatment recommendations are not necessarily fully shared by modern haematologists!
Some people experience remission, while others may have chronic ITP requiring ongoing management.
Complete remission is defined as a response to treatment with platelets increasing to ≥100. Note that a normal platelet count is around 150-400, so the goal of treatment is not necessarily to restore normality. Remission is the first step to cure (cure is a permanent remission) but in many cases remission will be lost as the platelet count falls.
Many women with ITP can have successful pregnancies, however it is recommended that you discuss your plans prior to pregnancy with your treating doctor and ensuring that your doctor and obstetrician are liaise closely as you are monitored throughout your pregnancy.
Do you have other questions you’d like to ask about ITP?
Get in touch with us at info@ITPAustralia.org.au, and we can contact our knowledgeable Medical Advisors and help answer your questions.