Late last year I went in for an annual physical, part of which (as you might imagine) involved a blood draw.
When the results of the draw came back, the physician informed me that everything looked good except that I was “anemic”.
I didn’t really know what that meant except that I thought it had to do with blood, iron, and oxygen delivery.
My mom had told me in passing a few times that my grandfather has pernicious anemia, but I never really asked too much about it.
The physician then told me she was going to write me a prescription for vitamin B12 and sent me on my way.
First, I thought it was ridiculous that the physician did not ask me anything about my diet or pursue further testing to understand what was at the root cause of my abnormal lab values.
After all, what if I weren’t eating any B12 and could solve the problem through food?
What if I were experiencing some sort of illness or condition that was impairing my absorption?
Nothing but a prescription.
Second, and more relevant to this blog post, I had no idea what exactly anemia was, or why it was vitamin B12 specifically that the physician prescribed and not iron (which is what always came to mind when I heard of anemia).
In this third part of our exploration of my recent blood test following 30 days of a carnivore diet, we’re going to discuss the results of the Complete Blood Count (CBC) portion.
We’re not only going to discuss my results, but we’re also going to briefly discuss what’s being tested, what the results might mean, a little bit about anemia, and even some genetics.
Oh, and as mentioned in other articles, I’m not a doctor or licensed physician.
Don’t make any decisions based on what you read in this article or any of my blog posts.
Let’s get started talking about what’s in our blood and what’s shown on a Complete Blood Count (CBC) panel.
Red Blood Cells
Red blood cells, also called erythrocytes, carry oxygen (O2) from the lungs throughout the body, and carbon dioxide (CO2) from the cells of the body back to the lungs.
Hemoglobin (Hb) is the protein responsible for O2 delivery in red blood cells.
Hematocrit is the volume of red blood cells relative to the total volume of blood, expressed in g/dL.
Low levels of red blood cells, hemoglobin, and/or hematocrit can reflect anemia, a condition of insufficient quantity or quality of red blood cells for O2 delivery.
There are other red blood indices we can use along with red blood cell count, hemoglobin, and hematocrit to analyze any abnormal values:
Mean corpuscular volume (MCV) is the size of the red blood cells.
Mean corpuscular hemoglobin (MCH) is the amount of hemoglobin per red blood cell.
Mean corpuscular hemoglobin concentration (MCHC) is the amount of hemoglobin per unit volume.
White Blood Cells
White blood cells, also known as leukocytes, are a part of the body’s immune system.
There are three major classes of WBCs – monocytes, lymphocytes, and granulocytes.
Monocytes, also called macrophages, are “scavenger cells” that travel through the blood where they surround and dispose of microorganisms, foreign particles, dead cells, and boost immune function.
Lymphocytes come in three flavors (figuratively) – B-cells, T-cells, and natural killer (NK) cells.
B-cells produce antibodies to fight bacteria, viruses, and toxins from outside the body.
T-cells fight infection and cancer by destroying the body’s own cells once affected.
NK cells, similar to T-cells, fight infection and cancer by destroying the body’s own cells once affected
Granulocytes, which come in three types – neutrophils, eosinophils, and basophils – release enzymes during infections, allergic reactions, and asthma.
Neutrophils are one of the first immune cell types to travel to infections and release enzymes to kill microorganisms.
Eosinophils release enzymes during to infections, allergic reactions, and asthma.
Basophils release enzymes during allergic reactions and asthma.
Platelets are small pieces of cell that help with blood clotting to slow or bleeding and help wounds heal.
Iron is a mineral that is used to make hemoglobin, and is found in red meat, fish, poultry, lentils, beans, and foods with iron added.
Along with levels of iron circulating in the blood, we look at a couple of other things to get a feel for iron status:
Transferrin, the protein that carries iron throughout the blood and is used to calculate the iron binding capacity.
Ferritin, a protein that contains iron that is stored in cells and can reflect the total amount of iron in the body.
Now that we’ve done a crash course in blood, let’s look at mine.
Shown in the table below are my blood values from before (Aug-18) and after (Sept-18) my 30 days of carnivorous eating.
Values that are out of the reference range are in red text.
My red blood cell count, hemoglobin, white blood cell count, and iron levels all rose from below the reference range to within the reference range.
However, both my red blood cell count and white blood cell count are still barely above the minimum reference values and other resources suggest that they both are still a bit low.
We see also that my MCV and MCH were and are still elevated, and that my blood iron had previously been low but are now within range.
So, my low red blood cells, hematocrit, hemoglobin, and red blood cells indicate that I am, indeed, anemic.
My low white blood cells could indicate a variety of problems and appear to be in better shape than my red blood cells, so let’s start with the anemia.
Anemia has three main causes:
- Blood loss
- Lack of red blood cell production
- High rates of red blood cell destruction
I haven’t had any crazy wounds or surgery, and (believe it or not) haven’t had any heavy menstruation, so identifying form of chronic blood loss would require further testing.
Had I requested a measure of my reticulocytes (younger red blood cells), we could calculate a value called the reticulocyte production index to get a feel for whether the anemia might be due to lack of red blood cell production or high rates of destruction.
I didn’t get reticulocytes measured, though, so we’re going to have to pass on that option.
What we can do, though, is look for signs of nutritional deficiencies, as insufficient iron, folate, or vitamin B12 can prevent red blood cell production.
The obvious first step would be to look at my eating habits.
Below is a screenshot of my average micronutrient intake over the 30 days prior to the August blood draw:
Looks like plenty of iron, folate, and B-12 there.
Below is a screenshot of my average micronutrient intake over the 30 days prior to the September blood draw:
Folate is lacking, but plenty of iron and B12.
I’m going to go ahead and rule out iron deficiency.
While my total iron had previously been low at 44 ug/dL, suggesting that it might be the cause, it’s now within range.
Additionally, my ferritin – which you’ll recall reflects total iron in the body – looked normal in both tests and I haven’t been experiencing any of the symptoms of iron deficiency anemia.
Finally, there are a few factors leading me to lean more towards folate and/or B12:
- Elevated MCV (macrocytosis) can be a sign of folate and B12 deficiency
- My relatively low white blood cell counts could also indicate potential folate or vitamin B12 deficiencies
- My mom always did tell me that my grandfather had pernicious anemia
- My experience earlier this year in which the physician prescribed me vitamin B12
Considering that my estimated dietary intake of both nutrients was sufficient leading up to the first test and my dietary intake of vitamin B12 was sufficient leading up to the second test, there’s a possibility that intake isn’t the issue so much as absorption or utilization.
From what I gather, there are several reasons that one might not be absorbing B12:
“inadequate [intrinsic factor] production, atrophic gastritis, interference with the ileal uptake of vitamin B12 due to disease, resection or interference by bacterial overgrowth, drug-nutrient interactions as well as some less common genetic defects.”
One of the more common causes of folate malabsorption is a conditioned called hereditary folate malabsorption.
I have no clue if I’ve got a lack of intrinsic factor, or if I’ve got some funky gut stuff going on, but perhaps my genes are playing a role in all this.
After all, I am my grandpa’s grandson.
Fortunately, I’ve had my DNA analyzed through a tool called Promethease that might give us some clues.
I didn’t find any mention of hereditary folate malabsorption (a mutation of the SLC46A1 gene), but I did find a few other mutations that might not be helping me out too much.
I’ve got a variation of the rs1801133 SNP that results in approximately 65% effective folate metabolism, a variation of the rs1801131 SNP that results in impaired conversion of folate from one form to another, and a variation of the rs60662 SNP that is associated with lower vitamin B12 values.
How much of a role are these genes playing in my current condition?
I have absolutely no idea, but it’s worth noting, and good to know.
Understanding that I have a genetic predisposition for poor B12 and folate utilization puts me in a better position to keep an eye on those nutrients.
So, what am I going to do with this information?
Well, I’m just not sure.
I’ve continued eating nothing but beef, salt, and water since the September blood draw and will be getting another draw in a couple of weeks at the 60-day point).
By then, I should have a clearer picture of how my blood work is changing with this way of eating.
If my anemia and leukopenia continue to improve, then I probably won’t sweat it too much.
That said, I do intend after this next blood draw to start making some changes regardless of what I see in my blood work.
I’ll be incorporating some organ meat and eggs into my routine (hello, micronutrients!) and might also pump the brakes on my deliberate overfeeding, since the ol’ pants are getting a little snugger than I’d prefer.
I’ve also been experimenting with my salt intake lately, and have some interesting observations from that effort that I’ll be writing about eventually
Ultimately, though, I’m just not sure where I’m headed with all of this.
I’m just enjoying how I feel, enjoying what I’m learning, and enjoying the simplicity of this way of eating.
I’ll be sure to keep you in the loop as this whole experiment continues.
Until next time, have a most excellent week!