Wisdom Wednesday: The Complete Blood Count (CBC)

This is the most common laboratory test performed – CBC with differential. It is divided into three segments – the red blood cells (RBCs), the white blood cells (WBCs), and the platelets. Today’s blog will concentrate on the RBCs.

The conventional RBC normal range is from 4.6-6.0 million/uL for men and 3.8-5.1 million/uL for women. The functional range for men is 4.2-4.9 and 4.0-4.5 for women. Red blood cells are the most common blood cell making up 25% of all the cells in the human body. They carry 98% of all oxygen to tissues.

Young RBCs are called reticulocytes. Although it takes two days to produce one RBC, your body produces 2.4 million per second.

RBCs have a life span of 120 days and are filtered by the spleen. They are very flexible, flowing easily through the small capillaries and can circulate the body in 20 seconds.

A decrease in the RBC count can be caused by anemia, chronic liver or kidney dysfunction, free radical damage or blood loss. The RBC count increases in dehydration, asthma or respiratory distress, vitamin C deficiency and Polycythemia.

Hemoglobin is the iron carrying portion of the RBC. Four molecules of oxygen can attach to each molecule of hemoglobin. The laboratory range for hemoglobin is 12-16 g/dL but I prefer 14-15 for males and 13.5-14.5 for females. The hemoglobin is decreased in iron deficient anemias, nutritional deficiency, intestinal parasites, internal bleeding, vitamin B6 or copper anemia. It is increased in dehydration, Polycythemia, adrenal dysfunction, asthma, spleen hypofunction and elevated testosterone.

The hematocrit (HCT) measures the percent of RBC’s in the blood. The laboratory range is 36-50% in males and 34-44% in females. I narrow that slightly for the functional range. The hematocrit is a key component of anemia and dehydration screening.

Wisdom Wednesday: Ashwaganda

This is the most commonly prescribed herb in my office. I’m surprised that I have waited so long to write about its virtues. Ashwaganda is an Arevedic herb from India. Its use dates back 6,000 years. The name means “to have the strength of a thousand horses”.

In China, the same herb is called Withania. In TCM (traditional Chinese medicine), the herb is prepared as a tea. In India (western herbalogy) the active ingredients are extracted in alcohol over the course of several days. This is very important as alcohol is an organic solvent. Many of the organic compounds in Ashwaganda do not dissolve in hot water but will dissolve in alcohol. So although the names are interchanged frequently, they are not really the same herbal preparation.

Ashwaganda is an herbal adaptogen. Please review my blogs on The Endocrine System and Hidden Adrenal Issues. Adaptogens must be able to restore the adrenal cortex and medulla in addition to facilitating DNA repair. Only a few substances have been found on the planet that are capable of this level of healing and all of them are herbs.

The major components of the Ashwaganda are steroidal compounds and alkaloids. The plant stores these chemicals in the root which is the only part of the plant used in herbal preparations. It has no known interactions but is contraindicated the first trimester of pregnancy as studies with female mice have shown some antifertility effects.

Acid-Suppressing Drugs Linked to Vitamin B12 Deficiency

A new study published in the Journal of the American Medical Association reports that people who use certain acid-suppressing drugs for two years or longer are at increased risk of vitamin B12 deficiency.
December 10, 2013

This can lead to anemia, neuropathy, depression, fatigue, or dementia. The drugs are proton-pump inhibitors, or P.P.I.’s and histamine 2 receptor antagonists. They are available by prescription and over the counter under names like Prevacid, Prilosec and Nexium. Nearly 157 million prescriptions were written for P.P.I.’s in 2012.

“People who are taking this medications are more likely than the average person to be vitamin B12 deficient, and it’s a potentially serious problem,” said Dr. Douglas Corley, senior author of the study. Of note, the study was funded by Pfizer, which makes a P.P.I. called Protonix.

Patients who took P.P.I.’s for more than two years were 65 percent more likely to have a vitamin B12 deficiency, the researchers found. Higher doses of P.P.I’s were more strongly associated with the vitamin deficiency, as well.

MY TAKE:
These drugs prevent the stomach from manufacturing hydrochloric acid (HCl) thus reducing the symptoms of acid reflux. However, HCl is the first major step in digestion. It breaks down protein, separates calcium ions from their substrate, and prepares vitamin B12 for assimilation in the small intestine. It is also the triggering mechanism for the gallbladder to release bile and the second major step in digestion once the food bolus enters the small intestine. We now know (and have predicted) that P.P.I.’s cause osteoporosis, anemia, dysbiosis, and chronic Candida infections. Clinically, I see frequent gallbladder congestion associated as well.

Unfortunately, if you burp once in a while, that seems to be enough criteria to prescribe one of these drugs. A simple test of the pH of the stomach will detect over-acid production, but the testing is seldom run. A lack of HCl production will also cause acid reflux, as the food putrefies, producing organic acids in the stomach. It is estimated that a lack of HCl accounts for 50 percent of the cases of acid reflux.

The cause in most cases is poor diet. Food sensitivities, over eating, excessive fat and sometimes even poor food combining are real issues. When a patient obtains relieve from the drug, they continue their poor eating habits further compromising general health.

THE BOTTOM LINE:
Avoid these P.P.I,’s like the plague! Your symptoms are warning signals that the digestive tract is in trouble. Have your diet evaluated. Often just reducing caloric intake will dramatically improve or eliminate symptoms.

Vitamin B12 – Are You Deficient?

In a word, YES, you may very likely be deficient in vitamin B12. The most common food source is red meat. So if you are a vegetarian, or limit your animal foods to fish and chicken, you need to supplement. But even if you are an “all American red meat eater”, a real carnivore, the odds are pretty high that you are still deficient.

Much has been written about how hard it is to absorb B12. You need adequate HCl (depleted by Prilosec and all the other protein pump inhibitors). You need intrinsic factor and healthy epithelial lining in the small intestine. While these are significant issues, the real issue is conversion.

The food form of vitamin B12 is cyanocobalamin. If all the factors listed above are working and B12 is absorbed into the lining of the small intestine, it must be converted to one of the bio-available forms to be used by the body. Methylcobalamin and adenocobalamin are the two bio-available forms that are produced by those small intestine cells. Once converted, both forms are released into the blood stream and go to work. Vitamin B12, folic acid, and vitamin B6 are involved in many, many chemical pathways in the body.

The ability to convert vitamin B12 is controlled by our genetics and unfortunately many of us have a genetic impairment that limits or prevents us from converting B12. Eight percent of the population have inherited a defective gene from both parents and will never make the conversion. These patients are easy to identify as they are always be anemic (have a low red blood cell count, low hemoglobin, or low hematocrit) because B12 is necessary to make red blood cells. The more common issue is the person who inherited a defective gene from just one parent. Sometimes they can convert B12, sometimes not. If they are under stress from illness, poor diet, lack of exercise, long work hours, etc., they may not convert B12. Twenty-five percent of the population is afflicted with this genetic defect. That’s one of every four people!

So, looking at all the issues with vitamin B12, it’s a pretty good guess that you are deficient. Not quite 50/50, but close. Fortunately, the solution is quite easy. The bio-available forms of B12 – methylcobalamin and adenocobalamin are readily available in supplement form. You can also take a sublingual form that is absorbed without passing through the digestive tract. Clinically, I find that that supplementing the patient with partial impairment for 30 days will often restore normal conversion, eliminating the need to supplement.

Let’s discuss B12 shots briefly. Most of the injections contain cyanocobalamin, the food quality form. When you inject the food quality form into the tissues of the body, where does the conversion occur? The vitamin never has an opportunity to be converted by the cells of the small intestine. All injections of B12 should be either methyl or adenocobalamin, not cyanocobalamin.

If you look at your last blood test, the lab probably ran a CBC (complete blood count). It’s a common lab test. If the RBC count, hemoglobin, or hematocrit are low, you might need more vitamin B12. If the MCV (mean corpuscular volume) is above 92, you are probably deficient in B12 and/or folic acid.