by Dr. Laura Korman, DC   

Anemia is a state in which the body is deficient in its ability to deliver oxygen to various tissues, muscles and organs, including the brain. This condition is quite common—especially in children, adolescents, athletes, pregnant women, and those with heavy or frequent menstrual cycles. Most people don’t know that two types of anemia exist, so before you reach for that bottle of iron pills, you should be aware of their differences. 

The two primary types of anemia are diagnosed with blood tests, including a Hemoglobin (Hgb) and a Mean Cell Volume (MCV) test, which measures the size of the cells. These two tests are part of a CBC panel regularly ordered by a primary care physician. When looking at a Hgb level, the “normal lab value” a doctor generally uses to diagnose anemia is between 11.1-15.9g/dl. But an “optimal” level used by a Functional Medicine Practitioner will be in a narrower range of 13.5-14.5 for women and 14.5-15.5 for men.  

Anything higher than the upper range can mean an iron overload, while anything under the lower limit indicates anemia. Even a mild anemia indicates the patient is suffering from a lower level of oxygen to their body and brain. The next question to answer is what kind of anemia does the patient have—an iron deficient anemia or one caused by low vitamin B levels? This can be determined by looking at the MCV marker.  

If this level is on the lower end—below 90—it will most likely indicate an iron deficiency anemia, and other tests such as a serum iron and a ferritin (stored iron) test can be run to confirm this diagnoses. However, if  the MCV runs on the higher side—greater than 90—it might indicate a deficiency in either B12 or Folate (B9). The tricky part here is often in differentiating between these two.  

Typical tests for B vitamins use serum blood levels. Serum is the clear part of the blood which does not contain any red blood cells (where the body actually uses these vitamins). I often use an analogy to compare red blood cells flowing in serum to boats floating on a river. The river might be full of fish, like the serum might be full of vitamins, but if you can't get the fish into the boat or your vitamins (in serum) into the cells, they will not offer any benefit. 

We can more accurately measure a true B vitamin deficiency by running a blood test called Homocysteine. This test is a “functional” marker for B vitamin levels that, when elevated, indicates the body does not have enough B12, Folate or B6 to metabolize or break it down adequately. To further differentiate between a Folate and a B12 deficiency, we can run another functional test called a Methylmalonic Acid (MMA) test which, when elevated, specifically indicates a B12 deficiency.  

These Homocysteine and MMA tests are not part of the annual blood panels run by a doctor and, unfortunately, might not be covered by insurance. An important side note here is that a B12 deficiency can do more than cause anemia—it might also contribute to feelings of depression, confusion, poor balance, dementia and the development of neuropathy (tingles and numbness in the feet or hands).  

By taking a closer look at the CBC panel, you can detect the early markers of anemia, as well as most probable root cause—either an iron or B vitamin deficiency. Further functional medicine testing could be necessary to confirm the type of B vitamin deficiency. An accurate diagnosis of anemia is vital to provide you with the specific treatment for optimal oxygen delivery to the entire body and brain, as well as prevent the many long-term health consequences of iron or B vitamin deficiencies.   

For more information, call Dr. Laura Korman at 941-929-6700 or visit DrLauraKorman.com. Her practice is located at 16954 Toledo Blade Blvd., Port Charlotte.