Hello everyone and welcome to our 3rd article on chronic fatigue. In this article and our next we will be talking about the three most common types of anemia we encounter. I am going to talk about the different blood markers and numbers you may see on a blood test. It may get a little technical but I’ll try and keep it as simple as I possibly can!
Anemia is officially defined as low red blood cells (RBC) or low hemoglobin. Hemoglobin is the protein in your RBCs that helps you carry oxygen and carbon dioxide around your body. If you don’t have red blood cells or hemoglobin, you can’t oxygenate your tissues or run the citric acid cycle to create ATP, cellular energy. One of the hallmarks of anemia is fatigue, you often feel worse after exercise, can experience dizziness, cold hands and feet. With fatigue caused by anemia typically people feel wiped out even after sleeping because despite resting you still could not get oxygen to the parts of your body that need it!
Let’s talk about what blood markers you are likely to see. In a female, I am highly suspicious of anemia if the Red Blood Cells are below 4 even though most labs go as low as 3.8. Remember lab normal is set doing statistics and has nothing to do with when people start to feel sick. For males if the RBC is below 4.4 I suspect anemia. The hemoglobin marker levels to look for are if it is below 12.5 on a female or 14 in a male.
The next marker to look at is your MCV. This tells you how big or small your red blood cells are. If the number is >92 that tells you your red blood cells are large and this is commonly caused by a Folate (B9) and/or B12 deficiency. This is typically called “megaloblastic or macrocytic anemia”. For the record most official lab normals are up around 100 for the MCV, but in my experience if you are above 96 you are typically very sick. If your MCV is high then we’d like to actually check folate and B12 levels, and now the controversy in testing heats up.
I get many people who have had their B12 level tested and tell me it’s normal. Let me just say the test that is being run called the “B12 level” or “folate level” are horribly insensitive tests. Rather than testing B12 directly, the better test is called Methylmalonic acid (MMA) and Homocysteine . MMA compound is cleared by an enzyme dependent on B12, so if it has gone high you know you need B12. Homocysteine is cleared by enzymes dependent on B6, B9 and B12. Ideally the Homocysteine should be below 7 as above that range we see elevated risk for various inflammatory diseases. (For more information on Homocysteine and heart disease you can pick up a book called The Homocysteine Revolution by Dr. Kilmer McCully.)
Nutritional support for these types of anemia is a good mix of B vitamins if the Homocysteine is elevated and some B12 if the methylmalonic acid is high. In my office we use a sublingual B12 as it is absorbed well. Typical dosage is 1 mg a couple times a day until the patient feels better and the labs normalize. In some cases the B12 levels are so low we find B12 injections work faster than the sublingual in severely depleted patients.
In closing, if you are suspicious of anemia causing your chronic fatigue please look at your hemoglobin, red blood cell, and MCV values on a blood test. If the MCV is higher than 92 please consider running Homocysteine and Methylmalonic acid (MMA) to check on your B9 and B12 status as these tests are much more sensitive than the common folate and B12 direct level testing.
In our next article we will talk about some other forms of anemia including dysfunctions in iron metabolism causing anemia, and also the anemia of chronic inflammation.