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Posts Tagged ‘anemia’

Analyzing blood chemistry can be a very helpful tool in determining what a patient needs to improve their health, and of course why a patient is experiencing certain signs and symptoms. A patient will often bring in their blood work to me and tell me that the doctor who ordered the tests said everything was normal. Whether or not I agree that their tests are normal, these patients never understand what all the tests mean and how to interpret them. Of course, that’s the doctor’s job, but there are many patients out there who do want to understand and wish their doctor would explain the meaning behind them. Because of this, I decided to write a series of articles explaining what these blood markers mean and how they are relevant.

There are hundreds of tests that can be ordered via blood, but the basics are a “Complete Blood Count” (CBC) and (comprehensive) “Metabolic Panel”. Very often a lipid (or cholesterol) panel is ordered as well. In this first article I’ll go over how to read and understand the red blood cell markers that are included in a CBC.

A CBC reports three different cell types in the blood: 1) red blood cells, 2) white blood cells, and 3) platelets.

Let’s begin. Red blood cells are responsible for delivering oxygen from the lungs to the body tissues, and to take up carbon dioxide from the tissues and bring it to the lungs. The CBC includes information on seven different aspects of red blood cells (RBC). I’ll go over each individually.

1) “Red Blood Cells” (RBC) – This value refers to the actual number of RBC in a given sample size. When this is decreased, it means there is an insufficient number of RBC available to supply adequate amounts of oxygen to the tissues. This would be considered “anemia”. There are many types of anemia that may be present and describing each is beyond the scope of this article. Also, keep in mind that someone can be anemic and have a normal number of RBC. Red blood cells can be low in number because of iron-deficient diets, blood loss [normal (as in menstruation) or traumatic or pathological], malabsorption, pregnancy, or during growth spurts. An increased number of RBC is more rare to see, and that would typically be a result of dehydration. This is because dehydration would increase the concentration (or total number) of RBC in sample of blood that has a low amount of water in it. Additionally, RBC may be increased due to a bone marrow disorder (where RBC are made), low atmospheric oxygen (e.g.: high altitude areas), poor lung function, or a malignancy.

2) “Hemoglobin” (Hgb) – Hemoglobin is the oxygen and carbon dioxide-carrying portion of the RBC and is responsible for giving blood it’s red color. As the name suggests it is composed of heme, which contains iron, in addition to the protein “globin”. The amount of Hgb in the RBC is directly related to the amount of oxygen the RBC can carry. When Hgb is low, it usually indicates (iron-deficiency) anemia. And as with RBC, if it is high, it would usually indicate dehydration or the other conditions mentioned above.

3) “Hematocrit” (HCT) – The HCT is the percentage of RBC in the entire blood sample, and therefore is a measurement of RBC production. This would be low in most types of anemia and high in a dehydrated person or the other conditions mentioned above regarding RBC and Hgb.

4) “Mean Corpuscular Volume” (MCV) – The MCV is a measure of the average size of the RBC. This marker is key for identifying anemia and differentiating between the many types of anemia. Red blood cells start out large and shrink in size as they mature to become fully functional. If the MCV is high (meaning the RBC are larger than normal), it typically indicates a deficiency of folic acid and/or vitamin B12 because these are the two nutrients required for RBC to mature (and shrink in size). When the MCV is low (meaning the cells are smaller than normal), it usually indicates iron deficiency as there is actually less volume to the cell because there is less mass with insufficient amounts of iron. There are other reasons this value can change due to other types of anemia, which is beyond the scope here.

5) “Mean Corpuscular Hemoglobin” (MCH) – The MCH is a measure of the average amount of Hgb in each RBC. This value helps with determining the severity of anemia. MCH is typically low in iron-deficiency anemia and might be high in B-12 and/or folate-deficiency (megaloblastic – meaning large cells). It would be high in megaloblastic anemia because the cell is larger and therefore has the ability to contain more Hgb.

6) “Mean Corpuscular Hemoglobin Concentration” (MCHC) – The MCHC is (just what it sounds like) a measure of the concentration of Hgb in a given amount of RBC, and will most likely be low or high for the same reasons as MCH. This value is especially useful in monitoring therapy for anemia.

7) “Red Blood Cell Distribution Width” (RDW) – The RDW is a value that measures the average size of all the RBC present in the sample. A low RDW would indicate that most RBC are too small as in the case of iron-deficiency. And a high RDW would point to there being too many large RBC as in B12 and/or folic acid-deficiency anemia. It would certainly be too high or low because of other types and causes of anemia.

Keep in mind that this article does not cover all types and causes of anemia. It is intended as a guide to understanding the terminology used on blood tests and some of the most common reasons for abnormally high or low values. Additionally, the reference ranges for normal values can, and often do, vary from lab to lab. This is because the reference ranges are typically determined from averages that the labs have constructed based on the many samples that they have tested. As a result, I usually find these ranges too wide to assess the risk for disease before it develops. When the blood values are outside of the lab’s reference ranges, a disease (or disease process) is usually already in place. I prefer to assess blood work using more narrow, “functional” ranges that can detect disease before it is “full-blown”, and to prevent disease.

Clinical pearl: when a patient is doing “everything right” for themselves (i.e.: diet, exercise, proper supplements, etc.) but they do not respond to those treatments; usually a sub-clinical anemia can be found. Without proper oxygen supply to the body’s tissues, there is little to no chance the body will be able to heal or function better.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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According the Associated Press (AP), every single fish tested from nearly 300 streams in the US were found to be contaminated with the toxic metal mercury.  However, “only about a quarter had mercury levels exceeding what the Environmental Protection Agency says is safe for people eating average amounts of fish”.  The EPA states on their website that “a variety of fish and shellfish can contribute to heart health and children’s proper growth and development”.  And then go on to say the following “women and young children in particular should include fish or shellfish in their diets due to the many nutritional benefits”.  “For most people, the risk from mercury by eating fish and shellfish is not a health concern.”  “Yet, some fish and shellfish contain higher levels of mercury that may harm an unborn baby or young child’s developing nervous system.”  Finally they state the obvious – “The risks from mercury in fish and shellfish depend on the amount of fish and shellfish eaten and the levels of mercury in the fish and shellfish.”

Some more specifics of what the EPA has to say: “Do not eat Shark, Swordfish, King Mackerel, or Tilefish because they contain high levels of mercury.  Eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury.  Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish.  Another commonly eaten fish, albacore (“white”) tuna has more mercury than canned light tuna. So, when choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of albacore tuna per week.  Check local advisories about the safety of fish caught by family and friends in your local lakes, rivers, and coastal areas. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don’t consume any other fish during that week.”

Before I continue on the dangers of ingesting mercury, I want to mention how mercury winds up in fish to begin with.  Basically, it is from coal-burning power plants that emit smoke stacks of pollution.  These emissions obviously get into the air and then settle into the oceans, lakes, rivers, streams, and ground near this water.  Oh wait, I presume the mercury in that pollution must also get into our reservoirs, but I haven’t seen that mentioned.  Perhaps because people are focusing on fish, when it comes to mercury.  Anyhow, the legislation that was supposed to be implemented forcing companies to control those emissions has been disgustingly delayed.  About.com had an article stating this: “By law the Environmental Protection Agency is obligated to require power plants to cut roughly 90 percent of their emissions of mercury and other toxic pollution by 2008. Instead, in March 2005 the agency let polluters off the hook, requiring much smaller reductions and giving electric companies more than two decades to accomplish them. What’s more, the agency essentially allowed polluting companies to do nothing for the next 12 years.”  Please see the link as there are more facts about fish and not just the politics behind the pollution.

Mercury is known to be extremely toxic to the nervous system in particular.  The EPA states that mercury can cause harm to the brain, heart, kidneys, lungs, and immune system in people of all ages.  For fetuses, infants, and children the major effect is impaired neurological development.  Lastly, the EPA says (and I can’t get over this one!): “In addition to the subtle impairments noted above (referring to the previous sentence), symptoms of methylmercury poisoning may include; impairment of the peripheral vision; disturbances in sensations (“pins and needles” feelings, usually in the hands, feet, and around the mouth); lack of coordination of movements; impairment of speech, hearing, walking; and muscle weakness. People concerned about their exposure to methylmercury should consult their physician.”  Bold type-face, underlining, and statement in parentheses added by me.

OK, now I’ll comment.  How does the EPA know what’s safe for you?  What symptoms must occur for certain amounts to be considered unsafe?  Also, I unfortunately can’t find information on how they determined safe levels, and of course, the state of the health of those people (presuming tests were done on humans?).  Please comment if you know.  But regardless, do they know the toxic burden (of all toxins) that already exists in you?  Do you know?  Remember, we ALL have some level of a toxic burden of chemicals and metals in us; from simply breathing the air, consuming conventionally grown foods, etc….the list is endless.  Do you have all the necessary nutrients to drive the kidney detoxification pathways?  We often think of the liver as the main detox organ, however, toxic metals are water-soluble and will be excreted through the kidneys into the urine.  As an aside, any time I find a patient’s most “stressed” organ(s) to be the kidneys or bladder, I think toxic metals first.

My points above are meant to reflect the concept that you probably won’t experience the above OVERT and OBVIOUS symptoms of mercury toxicity as reported by the EPA, by consuming fish alone.  That is from my personal experience with patients.  The problem arises when people have sub-clinical symptoms from mercury toxicity.  These might include fatigue, irritability, “foggy-headedness”, depression, anemia, hypothyroidism, digestive complaints, and more.  Sub-clinical mercury (or other toxic metal) toxicity often results in the scenario of: “Mr./Mrs. Smith, all of your tests came back normal”. Let me expand on this.  It will be extremely uncommon for a person to have mercury levels elevated in their blood.  To date, out of literally hundreds of patients of I’ve seen with mercury-related symptoms, or other toxic metals, ONLY 1 actually showed elevated levels on blood tests.  And this is how conventional doctors often go about checking for it.  The problem is often that the metals get lodged into the cell/soft tissues and don’t get fully released into the bloodstream.  When in the cells/soft tissues, they can cause impairments of normal functioning leading to the above symptoms.  Fortunately, there are functional lab tests (especially urine) that can be used to detect levels of metals in the soft tissues.  Even though urine is a reflection of blood, the test involves “provoking” the metals out of the cells to get an accurate measurement of total body burden in the soft tissues.

The amount of mercury-laden fish you can consume without harm or causing symptoms will depend on a variety of factors; mainly your current “toxic-burden” and detoxification abilities.  And as you know, your symptoms may already be stemming from mercury (or other toxic metal) exposure; so perhaps you shouldn’t consume any fish at all.  It would be prudent to have functional (in-office and lab) tests performed to find out!  Lastly, I have helped many patients with symptoms related to toxic metal exposure by correcting simple and easily identifiable nutrient deficiencies, and education on avoiding further exposure.

I still can’t understand why some practitioners in the dental community consider it OK to put mercury in their patients’ mouth!!!  By the way, there is a right way and a wrong way to have mercury amalgams removed.  It can be more harmful to have mercury fillings removed, when done “improperly”.  Feel free to e-mail me if you have concerns about that.

One more thing.  You may go “MAD” if you are exposed to too much mercury.  The phrase “mad as a hatter” comes from the hat-making industry dating back to the 1800’s when some hat-makers apparently went “mad” because of breathing mercury fumes from a solution they used to make fur into felt.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Let’s talk about two common types of anemia I see in my patients.  They are self explanatory like iron-deficiency anemia.  Megaloblastc anemia refers to a deficiency of folic acid and/or vitamin B12, and pernicious anemia refers to B12-deficiency specifically.

Every single cell in your body requires folic acid and vitamin B12 in order to “mature” and therefore function properly.  All cells start off immature (and large in size) and become smaller when they mature.  Thus, the term “megaloblastic” refers to the fact the cells stay large in size (mega) without these vitamins. “Macrocytic anemia” is also a term for this condition.

In regards to folic acid deficiency, we run in to some of the same situations as in iron-deficiency – when asking the question: Why is their a deficiency?

The answers are either: a) insufficient consumption of foods containing folic acid; b) lack of absorption; c) an inability to convert folic acid to its active form, and d) complications of its utilization from certain drugs.

In regards to answer “a”, you must obviously consume folic acid through the foods you eat. Some of the best foods that contain high amounts of folic acid (or folate as it is referred to when in food) are: lentils, beans peas, broccoli, spinach, collards, okra, asparagus, and citrus fruits.

As far as answer “b”, regarding absorption – this could result from:

1) Your intestinal villi are literally clogged up due to poor food choices, thus not allowing for absorption of folic acid (and most definitely other nutrients as well).  To “fix” this, you would need to change your diet, and probably have to take supplements that would help detoxify the small intestine.  Examples would be a whole food diet and/or fiber (to “scrub” them clean), bentonite clay (to absorb the toxins), and/or mucilaginous herbs that could help “dissolve” out the toxins.

2) Digestive conditions that can compromise the absorption of folic acid (and any nutrients) are: Crohn’s disease, ulcerative colitis, irritable bowel syndrome, leaky gut syndrome, colon cancer, and perhaps others.

Now for answer “c”.  Folic acid (or folate) needs to be converted to 5-methyltetrahydrofolate (5-MTHF) in order to actually perform its necessary functions at the cellular level.  This inability to convert usually results from a genetic defect. If there is a genetic defect, you may have to take a dietary supplement that contains the converted form.

The medications that interfere with folic acid utilization are: anticonvulsants (dilantin, phenytoin, and primidone), metformin (for diabetes), sulfasalizine (for Crohn’s disease and ulcerative colitis), triamterine (a diuretic), and barbituates.

Wait!  A few more things regarding less common causes (that I see) of folic acid deficiency are: alcohol abuse, kidney dialysis, and liver disease.  And as you’ll see below, more is required during pregnancy and lactation to prevent neural tube defects in the fetus; and for the growing baby.

Let’s now discuss vitamin B12 deficiency.  Why would someone be deficient?  The answers here are either: a) insufficient consumption of foods containing vitamin B12; b) failure to properly absorb B12; c) lack of a substance called intrinsic factor in the stomach (related to absorption); and d) inactive or oxidized B12.

Let’s start with answer “a”. Please be aware that B12 is only contained naturally in animal foods!  You can get certainly get it in vegetarian food sources, but that means it has been “fortified”.  Also, even though the algae product known as spirulina lists B12 on the label; apparently it is simply an analogue of B12 and may actually cause you to become even more B12 deficient.  Read this is you are concerned.  Foods high in B12 are basically every animal product known.

Answers “b” and “c” relate to an inability to absorb B12.  One possibility is for the same reasons as folic acid.  See above. Additionally, vitamin B12 requires a substance called intrinsic factor which is produced by (parietal) cells in the stomach, in order for proper absorption.  Stomach tumors, atrophic gastritis, pancreatic enzyme insufficiency, resection of the part of the small intestine that absorbs B12, autoimmunity towards the stomach cells or intrinsic factor itself, and an excess consumption of alcohol may be prevent B12 absorption through intrinsic factor complications.  See a reference here on the above.  “Pernicious anemia” refers to B12-deficiency anemia when the cause is specifically related to atrophic gastritis/destruction of parietal cells or destruction of intrinsic factor (usually from an autoimmune reaction).

Lastly, I’ll talk about “d”.  Vitamin B12 is known as cobalamin.  This is because the mineral cobalt a necessary part of the B12 complex.  B12 needs to be converted to methylcobalamin or hydroxycobalamin to actually get used properly, which depends on genetic factors.  If this conversion does not occur, B12 will be inactive.  Also, a person under oxidative stress (too many free radicals) may cause cobalt to become oxidized and again not allow B12 to work properly.  In this case, it’s possible to have normal B12 levels on blood analysis, but it will be inactive at the cellular level and thus not work. These people will need to decrease their exposure to free radicals; and mostly likely have to supplement with antioxidants and B12 also.

RDA’s for folic acid and B12 are in the following charts provided by the National Institutes of Health:

Folic Acid

Age
(years)
Males and Females
(μg/day)
Pregnancy
(μg/day)
Lactation
(μg/day)
1-3 150 N/A N/A
4-8 200 N/A N/A
9-13 300 N/A N/A
14-18 400 600 500
19+ 400 600 500

Vitamin B12

Age
(years)
Males and Females
(μg/day)
Pregnancy
(μg/day)
Lactation
(μg/day)
1-3 0.9 N/A N/A
4-8 1.2 N/A N/A
9-13 1.8 N/A N/A
14-18 2.4 2.6 2.8
19 and older 2.4 2.6 2.8

In conclusion, symptoms of folic acid deficiency are as follows: fatigue, diarrhea, loss of appetite, weight loss, weakness, sore tongue, headaches, heart palpitations, irritability, forgetfulness, and high blood levels of homocysteine (to be discussed in another article).

Symptoms of vitamin B12 deficiency are: fatigue, weakness, constipation, loss of appetite, weight loss, numbness and tingling in the hands and feet, difficulty maintaining balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue.

Blood tests can be run to determine folic acid and B12 status.  Especially a complete blood count (with “random distribution of weight” or RDW; and “mean corpuscular volume” or MCV) to check for the red blood cells’ size and associated anemias.  A blood test can also confirm a problem with the gene associated with failure to convert folic acid to its active form.

Vitamin B12 can be measured in blood, but remember if your cobalt has been oxidized, it can show normal levels when in fact the B12 isn’t working.  Methylmalonic acid is a good test (and rarely or never run) for B12 status.

And finally, homocysteine levels can spot a folic acid and/or B12 deficiency.  Homocysteine is related to cardiovascular and neurological problems.  Again, I’ll discuss that in another article.

I also use in-office, applied kinesiology muscle tests when I suspect deficiencies in these vitamins. HOWEVER, I still consider it prudent to use blood tests to see exactly what my patient’s levels are.

ANOTHER VITALLY IMPORTANT POINT! The blood lab’s ranges are often too wide to pick up sub-clinical deficiencies in these vitamins, that may still be causing your symptoms. I use narrower functional ranges for myself and my patients.

Proper food choices and quantities and/or supplements can correct deficiencies.  HOWEVER, do not take more than 1,000 micrograms of folic acid without B12.  This is because folic acid supplementation this high can trigger B12 deficiency symptoms.  In particular, it can cause IRREVERSIBLE nerve damage because of B12 deficiency.  Most supplements contain both vitamins together to prevent this. And the only supplements I’ve seen with 1,000 micrograms (and NO B12) in one tablet or capsule are prescription only. Go figure.

Well, that’s a lot to consider for just two vitamins.  But then again, they are obviously extremely important!

Some information in this article was derived from the National Institutes of Health website.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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It is quite common for a (female) patient to come to my office and tell me she is anemic. And very often, she has been diagnosed with it several months ago. My question is always: “Why are you still anemic if you found out about several months ago?” With the exception of some (rare) complications and rare types of anemias, there is generally no reason anyone should have iron-deficiency anemia for more than about four months.  And this type tends to be the most common, at least in my patients.  Let’s discuss why it occurs and how it can be incredibly simple to correct.  To start, anemia refers to “a condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume”.  If you are not sure, red blood cells need iron to carry and distribute oxygen around the body by way of the hemoglobin molecule.  By the way, the oxygen carrying molecule in muscles is known as myoglobin.

Iron-deficiency anemia is a “no-brainer” as to why it occurs; that is, lack of sufficient amounts of iron.  The question is always: Why?  There are three answers: a) you are not consuming enough iron, b) you are not absorbing enough, or c) you are losing blood faster than you are making it.  These can all exist together, too.

For answer “a” – this is simply not consuming enough iron-containing foods.  I almost always see this mostly in vegetarian or vegan patients.  Now, I’m not at all against being vegetarian or vegan, but I am against being deficient in vital nutrients that may come as a result of a particular diet.  Unfortunately, for vegetarians and vegans, iron is most abundant (by weight/mass) in animal foods.  Some good sources are: beef, chicken, turkey, pork, liver (beef, chicken, etc.), oysters, egg yolks and other animal foods; and kidney beans, blackstrap molasses, spinach, raisins, peas, dates, broccoli, almonds, apricots, and some other vegetarian/vegan foods.  Check the nutrition information on the foods for the exact amounts.  Here is a chart listing the recommended daily allowance (RDA) for iron according to the National Institutes of Health.

Age Males
(mg/day)
Females
(mg/day)
Pregnancy
(mg/day)
Lactation
(mg/day)
7 to 12 months 11 11 N/A N/A
1 to 3 years 7 7 N/A N/A
4 to 8 years 10 10 N/A N/A
9 to 13 years 8 8 N/A N/A
14 to 18 years 11 15 27 10
19 to 50 years 8 18 27 9
51+ years 8 8 N/A N/A

For answer “b” we come to the issue of iron absorption.  This can be caused by many factors.  Here are the most common ones I see.
1) Your intestinal tract can become literally be clogged up!  Iron is absorbed in the duodenum and upper jejunum of the small intestine.  There are little hair-like protrusions lining your small intestine which act to literally take up the food for absorption.  If your villi are clogged with old, undigested food from poor dietary choices, you may not be absorbing iron sufficiently (along with other nutrients as well).

2) You might not be fully breaking down the foods you are eating.  This can be due to improper chewing, or lack of hydrochloric acid and/or other digestive enzymes.  Deficiencies in minerals that stimulate the production of these digestive enzymes are one thing to consider; and possibly an enzyme supplement to help “prime the pump” while you are restoring those minerals.  By the way, iron-deficiency in a male or post-menopausal woman who is consuming enough iron in thier diet almost always results from lack of sufficient amounts of hydrochloric acid in the stomach.

3) Additionally, an outright digestive disorder like irritable bowel syndrome, Crohn’s disease, ulcerative colitis, and others may not allow for proper absorption of iron (and other nutrients).  So these conditions would need to be addressed as well.

By the way, iron from animal sources is called “heme” and from vegetable sources it’s called “non-heme”.  Please be aware that a non-heme source will be absorbed much better when combined with vitamin C in the same meal.  And phytic acid (or phytate) which is high in legumes and grains (e.g.: soy, kidney beans, wheat, rye, oats, barley, corn, and peanuts) will substantially inhibit iron (and other mineral) absorption.  However, vitamin C will also help to counteract the effect of phytic acid.

Lastly, answer “c” has to do with the issue of losing blood, faster than you are making it.

1) The most common cause that I see related to this is when women have a heavy menstrual cycle.  This is usually the result of hormone imbalances, especially a condition known as estrogen dominance.  I’ll discuss that in another article.  This is a rampant problem for females due to many reasons; and you won’t necessarily have heavy periods because of it.

2) Men and post-menopausal women (in particular) may become iron deficient due to gastrointestinal blood loss from digestive conditions like ulcers, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, colon cancer and other digestive disorders.  Also, excessive intake of aspirin or other non-steroidal anti-inflammatory medications (e.g.: Advil®, Motrin®, Aleve®, etc.) can cause blood loss through the gut.  These tend to be the most common reasons for blood loss, however their certainly are others.  And these conditions can obviously occur in menstruating women as well.
Let’s hope you are not losing blood because of undetected internal bleeding!

Now for the symptoms of iron-deficiency anemia.  Some common ones are as follows: pallor (pale skin and mucous membranes – nail beds and inner membranes under the eyeball can often/not always be spotted), fatigue, irritability, brittle nails, cold hands and feet (usually hypo-thyroid though), trouble concentrating, shortness of breath, irrregular heartbeat, mild depression, muscle fatigue/lack of endurance, and perhaps more.

Another strange symptom is called pica which a craving to eat ice (probably most common), soil, paper, soap, chalk, and other things I won’t mention.  This can be especially common in children.  The jury is still out on why it relates to iron deficiency.

The best blood test to run for iron-deficiency is ferritin (the amount of stored iron in your body.  But I’d also want to see levels of actual blood iron, total iron-binding capacity (TIBC), and transferrin (the molecule that transports iron).  And of course of complete blood count, which will measure total red blood cells, hemoglobin, hematocrit, RDW (random distribution of weight) and MCV (mean corpuscular volume).  Beware however, functional/sub-clinical iron deficiency can still (and often does) exist because the reference ranges considered normal by blood labs are extremely wide – so you will be quite deficient if you fall below the lab’s “normals”.

There are several applied kinesiology functional muscle tests that can cause me to suspect iron deficiency, especially one involving muscle fatigue/endurance.  And also in-office, cross-checks to help verify.  But I definitely consider it prudent to have blood levels checked for functional ranges; as an overload of iron can be very dangerous.  Get the blood tests and have them evaluated for functional ranges, it’s simple.

Finally, it can easily be corrected through diet and/or supplements.  And will most likely take a minimum of four months to correct, because the life-span of a red blood cell is about 120 days.  Hope this helps!

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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