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Anemia: Solving an All-Too-Common Mystery

In a recent article in The New York Times Magazine, “What Is Causing This Woman’s Life-Threatening Anemia?,” Lisa Sanders, M.D., relates the story of a middle-aged woman, Sherry, who has been battling anemia for 18 years.

Sherry’s doctors have run every test they could think of to identify the cause, but as of the date the story was posted were unable to solve the mystery.

Sherry’s doctors suspect she has an autoimmune condition, which is causing the destruction of her red blood cells. They have tried suppressing her immune system through the use of steroids and have even removed her spleen, where they suspected the blood cells were possibly being destroyed.

While these treatments have provided some partial or temporary relief, they have caused additional health issues, including a weakening of the joints (likely due to a combination of the anemia and long-term use of steroids at high doses); Sherry has had both hips replaced, and both shoulders replaced twice.

Sherry’s condition is unique and far more serious than the conditions of most people who suffer from anemia. Her red blood cell counts are significantly and chronically low, and they can drop dramatically with no apparent trigger (such as heavy bleeding).

However, many people suffer for many years with undiagnosed anemia or without any clear idea of what is causing it or what can be done to treat it.

What Is Anemia?

Anemia is a deficiency of red blood cells or hemoglobin— the red, iron-rich protein that binds to oxygen and, to a lesser extent, carbon dioxide.

Red blood cells carry oxygen from the lungs to other cells in the body, where the cells use oxygen to create energy. After delivering the oxygen, the red blood cells carry carbon dioxide from the cells back to the lungs and release it so that it can be exhaled. When the red blood cell count is low, or the level of hemoglobin within the blood cells is low, the red blood cells cannot deliver sufficient amounts of oxygen to the other cells in the body, leaving them literally gasping for air.

Symptoms of anemia include:

  • Fatigue/low energy
  • Unusually rapid heartbeat, especially during exercise
  • Shortness of breath (winded when climbing a flight of stairs)
  • Difficulty concentrating
  • Dizziness
  • Pale and listless appearance
  • Poor appetite
  • Dark urine
  • Slowed growth and delayed puberty
  • Jaundice
  • Enlarged spleen, liver, and heart
  • Bone problems
  • Headache
  • Coldness in the hands and feet
  • Chest pain
  • Easy bruising
  • Slow healing
  • Frequent or prolonged infections
  • Hair loss (mostly in women)

Additional symptoms associated with anemia may be present depending on the cause of the condition. For example, iron deficiency may cause a craving for paper, ice, or dirt; upward curvature of the nails (koilonychias), and cracking at the corners of the mouth.

Anemia caused by a vitamin B12 deficiency may result in tingling in the hands or feet, a lost sense of touch, and a wobbly gait or lost sense of balance.

What Causes Anemia?

Anemia can be challenging to diagnose and treat because so many different conditions can cause or contribute to it, including the following:

  • Aplastic anemia — a condition in which the bone marrow does not produce enough red blood cells.

    Aplastic anemia can be hereditary, which a person would know about it early in life, or it can arise later in life as a result of other causes, such as the following:

    • Exposure to common environmental toxins, such as pesticides, arsenic, and benzene
    • Radiation and chemotherapy
    • Medicines, including antibiotics
    • Infectious diseases such as Epstein Barr Virus, HIV, or hepatitis
    • Autoimmune conditions, lupus, and rheumatoid arthritis

  • Premature destruction of red blood cells. Red blood cells have a lifespan of 120 days. Anything that shortens their lifespan can cause anemia. As with aplastic anemia, causes can be hereditary (for example, thalassemia and sickle cell anemia) or arise later in life due to other causes, such as medication use, toxin exposure, or infection.

  • Nutrient deficiency (often referred to as B12 or iron anemia). A deficiency in iron, vitamin B12 or B6, or folate, or the body’s inability to assimilate or use a certain nutrient, can contribute to anemia. These deficiencies may be related to genetics, diet, chronic stress, medications that deplete nutrients, fatty liver, or autoimmune conditions.

  • Blood loss, which may result from gastrointestinal issues (such as a bleeding ulcer), menses, or surgery. Cancers and uterine fibroids can create anemias by diverting blood flow and increasing the body’s demand for iron or other nutrients.

A Commonly Overlooked Condition

Many people struggle with anemia for several years, feeling fatigued, having brain fog, apathy, and never being properly diagnosed. Even if they have been to a doctor, many anemias are easily missed, especially if they remain in a milder stage.

When anemias progress, they become more obvious. Unfortunately, by that time, many patients have been feeling poorly for far too long.

At BioDesign Wellness Center, we have experience seeing patients who have already visited their general practitioner and one or more internists or specialists and continue to experience debilitating fatigue. In many cases, labs have been run, and the patient has been told, “Your labs are normal.”

This form of missed diagnosis is commonly related to the way that doctors and nurses in the conventional healthcare system review lab results.

They typically skim through the lab report looking for red flags in the “abnormal” column. If something is abnormal, they may provide advice, or if the result does not strike them as sufficiently abnormal (is borderline), they may think it is not important enough to warrant discussion and treatment.

This approach may seem to make sense on the surface; after all, why would anyone bother wasting time looking at what’s normal or borderline?

Just look for the red flags and, if they are not present or appear irrelevant, move on. Unfortunately, this approach leaves people feeling as fatigued and frustrated as before, with no insight into what is going on and no treatment or the wrong treatment (such as an anti-depressant).

Our Approach

At BioDesign Wellness Center, we continue to dig for information until we solve the case. Even if a patient’s blood work and other lab results appear normal, we keep asking questions, such as:

  • Are other lab tests available that may provide additional clues? For example, testing for a chronic inflammatory response or autoimmune condition might explain fluctuations in blood counts (as would bleeding somewhere along the GI tract).
  • Could the test be interpreted differently because the patient is fatigued? For example, a lab result may show certain levels of nutrients on the low end of normal, which can cause problems for one person and not another.
  • Is any treatment available that could help even if the labs are normal? Here, we can start to intervene with changes to diet, including adding nutritional that target symptoms, as we continue to look for the cause.

We believe in taking further action to find out exactly what might be causing the problem. If we suspect anemia, this usually requires testing that goes beyond the typical complete blood count (CBC) and blood chemistry.

We need to dive into your history for clues and pay attention in the physical exam to the texture of your hair and nails, skin tone, and temperature.

We also ask you a lot of questions: Are your nails strong? Do they break easily? Are your hands and feet cold all the time? Do you feel tired all the time? A family history of autoimmune disease is also considered, as are your exposures to toxins such as benzene, arsenic, and pesticides.

To really understand what tests to run and what may be causing the problem, we take our time during the consultation — more than the quick seven to 12 minutes typical of a conventional doctor’s visit.

We provide an hour for the initial consultation. By listening, observing, and then following up with more advanced and targeted testing and interpretation, we dig down to the root cause(s), whether related to anemia or other condition(s), so you can get back to doing what you love, having the energy to excel in all you do, and feeling great doing it.


Disclaimer: The information in this blog post on Anemia is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from the medical staff at BioDesign Wellness Center, Inc., nor is this post intended to be a substitute for medical counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the recipient’s state, country or other appropriate licensing jurisdiction.