Hemoglobin Levels

[neithskye]

Hi everyone. Some background: I was diagnosed with type 2 diabetes in July 2018. Started LCHF and exercising. Six months later I've lost 30 pounds, reduced my A1C from 11.8% to 5.9%, and have been taken off two of three medications. I'm other words, I'm pretty healthy.

I regularly donate blood every three months. My last four hemoglobin levels were 146, 150, 150, and 141 g/L.

Today it was 118 g/L and I got deferred for the first time. I've always had good hemoglobin (and iron) levels.

I eat red meat, eggs, salad with broccoli. I take a daily multivitamin with 10 grams of iron. Does anyone have any ideas why my hemoglobin took a sudden nosedive?

 

[kitedoc]

Hi @neithskye, Good on you for being a blood donor. And for achieving a brilliant reduction in the HBA1C and your weight. Sorry your test results have thrown a spanner in the works !!
My basic understanding of anaemia is, based on reading not as professional advice or opinion and I am not absolutely sure it covers all causes: (see mayoclinic.org - Anaemia)
1) - not sufficient intake of iron, folate, B12 intake - but your diet contains all those things
2) - reduced absorption of one or more of those ingredients above:
- pernicious anaemia (B12 not absorbed due to antibodies); other B12 deficiency from fish tapeworm or metformin use;
- coeliac disease, gluten enteropathy - affecting absorption of all or any of three ingredients or some other enteropathy
- colitis, bowel inflammation affecting small intestine and absorption of three ingredients
3) - chronic inflammatory conditions like kidney or liver failure, rheumatoid arthritis etc
4) - inadequate manufacture of blood cells in bone marrow(BM): medication effects on BM; other toxic effects; diseases of BM
5) - increased destruction, removal of blood cells in the blood - abnormal Hb(like sickle cell), medication, disease
6) - increased loss of blood sufficient to outpace intake of iron/folate/B12 and production of blood cells - bowel, periods
Your doctor is the best person to consult about your Hb results, help sort out the cause. and advise on treatment.
I have italicised metformin in case this is the medication which you have taking all along.
Best Wishes for a quick sorting out and resolution of your trouble.

 

[neithskye]

Hi @neithskye, Good on you for being a blood donor. And for achieving a brilliant reduction in the HBA1C and your weight. Sorry your test results have thrown a spanner in the works !!
My basic understanding of anaemia is, based on reading not as professional advice or opinion and I am not absolutely sure it covers all causes: (see mayoclinic.org - Anaemia)
1) - not sufficient intake of iron, folate, B12 intake - but your diet contains all those things
2) - reduced absorption of one or more of those ingredients above:
- pernicious anaemia (B12 not absorbed due to antibodies); other B12 deficiency from fish tapeworm or metformin use;
- coeliac disease, gluten enteropathy - affecting absorption of all or any of three ingredients or some other enteropathy
- colitis, bowel inflammation affecting small intestine and absorption of three ingredients
3) - chronic inflammatory conditions like kidney or liver failure, rheumatoid arthritis etc
4) - inadequate manufacture of blood cells in bone marrow(BM): medication effects on BM; other toxic effects; diseases of BM
5) - increased destruction, removal of blood cells in the blood - abnormal Hb(like sickle cell), medication, disease
6) - increased loss of blood sufficient to outpace intake of iron/folate/B12 and production of blood cells - bowel, periods
Your doctor is the best person to consult about your Hb results, help sort out the cause. and advise on treatment.
I have italicised metformin in case this is the medication which you have taking all along.
Best Wishes for a quick sorting out and resolution of your trouble.

Thank you. I actually had my six months since diabetes diagnosis blood work done two weeks ago. My red blood count was normal and my hemoglobin was 130 (range is 120-160). So I'm not sure it's anemia.

The blood donor nurse said a lack of vitamin C could impede the absorption of iron into the blood or something so I wondered if something in my new LCHF diet was impeding something. Thanks for pointing out Metformin.

I'll go back to my doctor. My October blood donor hemoglobin level was 141, already decreasing from July's 150, which is when I started Metformin.

Of course Google is telling me low hemoglobin is due to all sorts of cancer so now I'm convinced I'm ill.

 

[kitedoc]

Thank you. I actually had my six months since diabetes diagnosis blood work done two weeks ago. My red blood count was normal and my hemoglobin was 130 (range is 120-160). So I'm not sure it's anemia.

The blood donor nurse said a lack of vitamin C could impede the absorption of iron into the blood or something so I wondered if something in my new LCHF diet was impeding something. Thanks for pointing out Metformin.

I'll go back to my doctor. My October blood donor hemoglobin level was 141, already decreasing from July's 150, which is when I started Metformin.

Of course Google is telling me low hemoglobin is due to all sorts of cancer so now I'm convinced I'm ill.

Hi @neithskye, That is the downside to google things but why should we all live in ignorance?? It is true that Vitamin C helps the iron in meat to be better absorbed but not the iron in broccoli. and similar vegetables. EDIT: please see @Dark Horse 's comment below. It is the other way round. Vitamin C helps with the absorption of iron in the vegetables.
When I started a LCHF diet as a Type 1, I looked up sources of Vitamin C and found that cooked broccoli, brussel sprouts, green and red peppers (we call them capsicums here), spinach, cabbage, turnip greens, tomatoes, kale, thyme, parsley, spinach all qualify.
In general I avoid fruit but will have some watered-down lemon juice during the hot summers and I make my own tabouleh with chopped parsley, tomato, chia seeds, garlic and lemon juice as a '4 out of 5' iron food!!

 

[Dark Horse]

Hi @neithskye, That is the downside to google things but why should we all live in ignorance?? It is true that Vitamin C helps the iron in meat to be better absorbed but not the iron in broccoli. and similar vegetables.
When I started a LCHF diet as a Type 1, I looked up sources of Vitamin C and found that cooked broccoli, brussel sprouts, green and red peppers (we call them capsicums here), spinach, cabbage, turnip greens, tomatoes, kale, thyme, parsley, spinach all qualify.
In general I avoid fruit but will have some watered-down lemon juice during the hot summers and I make my own tabouleh with chopped parsley, tomato, chia seeds, garlic and lemon juice as a '4 out of 5' iron food!!

Actually, it's the other way round. The iron in meat (haem iron) is the most easily absorbed but absorption of iron from vegetable sources (non-haem iron) can be increased by consuming them with vitamin C. The vitamin C converts the non-haem iron to haem iron so it is then absorbed more easily. http://www.icppharm.com/News-Resources/Articles/Effects-of-Vitamin-C-on-Iron-Absorption.aspx

 

[SimonCrox]

Hi,
As above, I think getting your GP's help is advisable

I do not know how they check the Hb level at blood donation, but it might be less accurate than a lab result from an armful of blood, so it is probably worth repeating along with renal function, B12, folate and ferritin levels..

If the anaemia is due to a lack of something to make the blood eg iron, B12, folate, then the blood has to survive longer and this falsely raises the HbA1c, whereas haemolytic anaemia can falsely lower the HbA1c

Low vitamin C levels are said to impede the absorption of iron, but I suspect taht one would have to have scurvy for this to make a real difference.

Best wishes

 

[kitedoc]

Thank you @dark House. I got that wrong. I was going on memory and obviously got the facts mixed.
Thank you for applying your biochemical knowledge and nous !!