Low Red Blood Cell Count, But Normal Iron Levels - Exhaustion
i've been doing low-carb/high-fat longer than a year now, fairly strict primal/paleo for about the last 4 months. I've been having exhaustion/brain fog issues for some years now (long before ditching grains and going LC), which going paleo hasn't solved (yet). I've experimented a bit with different macronutrient ratios with no success.
Last week i went to my doctor to get a general check, and we did a blood test. She said most of my markers are very good (cholesterol, triglycerides, blood glucose, thyroid, iron, calcium, sodium, kidney, liver, etc...), but the red blood cell count (erythrocites, hemoglobin, hematocrit) is lower than the normal acceptable range.
She said this is sometimes a symptom of anemia, however, she wondered that anemia is normally accompanied by low iron levels, which is not my case, my iron level is good. Because of this she wants to check if i'm losing blood, so we made a urin test and will make a stool test to check for blood. I'll probably get the result from the urin test today, and i still have to submit the stool sample.
I must admit i've been probably going too crazy with fish oil the last couple of months (maybe 6 capsules a day). Since i read that too much fish oil "thins" the blood (whatever that means), i decided to stay off it for a while (i stopped taking it about a week before the blood test).
Any ideas, dietary recommendations? What should i look out for in the results to my tests?
Just did a search on this and your post came up. Hopefully, you still read the forum. I just had a physical and saw the same thing as you did with regards to blood test. I also take fish pills but not as much as you do. One thing I am going to try is to increase my vitamin B12 via Methylcobalamin. I've been doing 80-90% Primal/Paleo and wondered if it is my diet change that has caused this. Could you please post if you were able to fix this or change your condition?
Very interesting about the fish oils. I was feeling horrible and went to the dr thinking my thyroid was shot. But come to find out I was severely anemic and my red blood cells were tiny, pale shrunken things in low numbers. I was practically dead. I have been taking 50-60mg of iron a day along with cod liver oil, and some other random supplements. It has helped my iron levels and brought my red blood cells almost back to normal. Now I am wondering if I cut out the cod liver oil for now if my numbers would go up faster?
Yeah, I'm starting to get that creeping feeling that my issue may be due to supplementing with too much fish oil. I'm usually a 9-9:30/mile runner and lately have been feeling exhausted during my runs. I use an HR monitor and have been training to keep my HR at 70% max, as Mark advocates. I'm running 10:30-11/mile and am still exhausted. Just had a physical and my RBC count was just below normal range. That's when I had an a-ha moment and could understand why I'm getting exhausted. Hopefully the B12 will restore my RBC levels. I'll also cut back on the fish pills. Was hoping Carlos was still around but he hasn't posted for a couple of years. Scary!
Did yout dr test ferritin, mcv and mch? Iron levels can be fine, but ferritin low which would cause iron induced anemia symptoms...if mcv and mch are low that would confirm...if mcv and mch are high suggests problem with b12 or folate
There is an easy test to see if fish oil is responsible. Compare your platelets before and after your 6 capsule fest. Fish oil can somewhat lower your platelet count. That's why you stop taking it before surgery and root canal. If your doc didn't mention it, you're probably low-normal, perhaps not low enough to be thrombocytopenic. But labs have wide ranges, especially at the low end. If you're a young guy and it's under 200, that would be low on an age-adjusted basis. So until your hemo rules out bleeding as being responsible for anemia, I would cut down on fish oil.
Originally Posted by carlosesteban
i'm still alive I haven't been on these forums for a while, Hispanicgamer's woke me up from hibernation
Unfortunately i haven't had any epiphanies or "a-ha!" moments concerning my issues. My red blood cell count is now on the lower side of the normal range, but i'm not sure what caused this "improvement" (and i use quotes because unfortunately i still have my problems with brain fog/tiredness, but i'll get back to that). Since i started this topic i changed two things in my diet: i stopped taking normal fish oil and replaced it with fermented cod liver oil (in much lower quantities), and i'm not eating low carb anymore. My reasons for not eating low carb anymore are a concern for possible thyroid issues (which i had for a while about 6 years ago, long before paleo), the possible negative effects of a low carb diet on the gut flora, and my activity levels.
However, as i said, i still have trouble with brain fog, especially in the evenings. I've been eating more moderate carb (ca. 150g) for about a year (from "safe sources"), but macronutrient ratios seem to have no effect at all on my energy levels.
Because of this i had an endocrinologist recently test basically everything there is to test: blood, testosterone, thyroid, urine, stool, allergies, etc., even sleep apnea. Everything normal, good even. The sleep apnea test didn't show any problems, but my sleep can be very uneasy. My endocrinologist then asked me about my mental state, and at this point i had to admit to not being really satisfied with many areas of my life and lacking motivation, which she says could be the cause of my issues. She proposed to put me on a mild anti-depressant, but for the moment i declined.
So at the moment i'm trying to change my job and my situation in life. Also, concerning diet, i'm trying 2 things:
1- Since i've had my share of antibiotics in my life, i'm trying to improve my gut flora by using a high quality probiotic (Prescript Assist, recomendation from Chris Kresser) and supplementing with resistant starch.
2- I've just realized recently that i might have a problem with histamine. I have frequent allergy-like symptoms, like a stuffy nose, a mild burning in the eyes, mild headaches and sometimes a mild cough after a meal. Allergy tests have always been negative. My diet includes foods very high in histamine: yogurt, kefir, sauerkraut, hard cheeses, dark chocolate, avocado, beef jerky, bacon, spinach, fermented cod liver oil, smoked salmon... i eat several of these things every day. So i decided to go low histamine for a while, but i just started a couple of days ago. As an experiment i took an antihistamine last thursday, and voilą, no allergy symptoms on friday. However, i felt extremely drousy, which is a common effect of antihistamines.
So there you have it. Sorry for the long post, but a lot of stuff happens in a couple of years. I hope some of it is interesting
Thank you so much for replying back carlosesteban! I feel like what you are going through is similar in many ways to what I'm going through.
Here's my info. I'm a 52yo male of Mexican/Japanese decent. Until August 2013, I pretty much ate the SAD diet. I shunned red meat and got most of my calories through carbohydrates. At 6 ft tall, I always seemed to weigh 195 lbs and could never seem to lose any weight even though I would run marathons and half marathons. Someone told me about this crazy new paleo diet and I found Mark's site and began my Primal journey.
One of the first things I did was track my food intake calories by composition. It was then that I saw I was a carbovore and after reading Mark's book, I decided to go Primal. I was able to take my weight down to 176lbs. and felt and looked great. However, in the past 3 months I had noticed that I seemed to be running out of gas during my runs. My heartrate would steadily climb while I tried to maintain my 9-9:30 minute pace. Soon my heartrate would be greater than 80% max and I would have to slow down. When I did my physical in February I saw that my RBC, platelet, and HCT numbers were "low" (see below). I came to MDA's forum and found two runners who had similar issues: carlosesteban and runner_79. Thanks to carlosesteban, whiskeybar, and codered I have had to rethink what I am doing with my diet.
I'm thinking that I may have pushed the envelope in my efforts to try and live a long life. I used to take 3-1250 mg capsules of fish oil in the morning and 3-1250 mg capsules at bed time. The reason why I did this was that I discovered that it put my Ulcerative Colitis into remission. I had been doing this for probably 10 years while on a SAD diet. I made the switch to Primal in August 2013 and felt great until about 2 months ago when I noticed I was getting out of breath while running and my heart rate would get above 70% max just to keep my old pace. During this time I was able to lose some extra weight doing the Bulletproof Coffee intermittent fast every morning. I don't think the BP coffee is the problem but since I'm essentially skipping a meal every day I could be placing myself into an anemic state? Some of my key blood test results are below.
What I have done is to decrease the amount of fish oil to 2 capsules at night only, I am now taking B12(5mg/day), and I will start to supplement with an iron pill every 2 days. I hope to get my numbers up and promise to post when I take another blood test in a couple of months from now. Thanks you all again for helping me to see through the dark on this!
Last edited by Hispanicgamer; 03-03-2014 at 09:32 AM.
Im glad this is being discussed. I was not aware fish oil might affect blood cell count..though i do not take fish oil. But i do have anemia. And there are anemias that are not related to iron deficiency. You may want to read up on thalassemia minor (fyi thal major is very different than thal minor). I have this type of thalassemia minor anemia, my red blood cell size is smaller than normal and i am easily fatigued. It may not be related at all to your situation but figured I'd mention it.
I started paleo eating june 2012 and it did help me lose weight and i think helped clear my brain fog a good amount. Prior to paleo i ate very SAD diet and especially for a couple years before i started paleo i felt really crappy.
You mentioned antibiotics, i had a bad experience with fluouroquinolone antibiotic (maybe because I'm anemic?) so i stress caution in taking that antibiotic.
Vitamin b helps me with energy...though i do need to increase my exercising which is my next focus.
Carlos, it's great that you're trying to rebuild the gut by taking probiotics and prebiotics (resistant starch). If you've taken one too many antibiotics, that could induce brain fog and put you in a funk. I believe PA is mostly for IBS but definitely experiment with mult-strain lactobacillus types, as there will be synergistic effect with prebiotics (RS) taken. Some of the bacteria that may have dwindled due to antibiotics may be responsible for producing neurotransmitters like Serotonin and Dopamin. You could be in a funk for that reason alone.
However, just because your numbers are within reference range doesn't mean things are alright. Endos are trained to flag numbers that fall out of the range, which are sometimes arbitrarily set, without regard to age or sex; they're also not qualified to interpret CBCs. Those second symptoms you list are immune-related. Look through your CBCs. Being low-normal could be a sign of immune dysregulation for items like Globulin, WBCs, Hematocrit, Platelets, etc., which all provide reference ranges that are too wide for flagging. You don't have to be 2 standard deviations away from the mean to be classified as "abnormal;" that system only flags 5% of the testing population, which is a sick sample set to begin with. I'm willing to bet all of the above items are probably low-normal. That in itself, combined with your low RBCs/Hgb, allergic symptoms and rhinitis, should refer you to a qualified immunologist/allergist to rule out immune disorders.
Originally Posted by carlosesteban
Last edited by Whiskey Bar; 03-03-2014 at 12:21 PM.