In last weeks Functional Friday, we discussed how to assess a B9/B12 need based on a marker found on most yearly bloodwork- the MCV, which stands for mean corpuscular volume (the size of the red blood cells).
While the lab range for MCV on the report is a bit broader, the functional range for the MCV is 83-91! When the MCV is below 83, one has microcytic red blood cells (often with anemia) which is usually due to deficiencies in nutrients needed to create hemoglobin. Microcytic red blood cells will be the topic of todays post!
So why are some red blood cells smaller than average ?
Like I explained in the previous post, red blood cells come from stem cells in the bone marrow that split once their nucleus has matured. To mature, the nucleus needs B9/B12. If the nucleus doesn’t have those vitamins to synthesize DNA, the cell does not split causing macrocytic red blood cells (large MCV). This is because the cytoplasm grew to create 2 cells (like it should), but the nuclei did not, since they lacked the nutrients.
Red blood cells are filled with hemoglobin which helps them carry oxygen around the body. Hemoglobin is also synthesized in the bone marrow from iron, as well as co-factors like copper, vitamin A, zinc and B6. If there is not enough hemoglobin, your red blood cells will be not be full, therefore they will be smaller (think of a balloon) 🩸 aka microcytic.
Making hemoglobin is a rather complicated process, many steps go into its making, the last one being the insertion of an iron molecule into the porphyrin ring. The enzymes that create hemoglobin are dependent on B6 and zinc, so if you are deficient in those, the iron molecule cannot be added and you won’t have enough hemoglobin.
Additionally, the iron that is in our bodies needs to be made bioavailable so that the enzymes can use it. To do so, we need Ceruloplasmin, which is the active form of copper. Ceruloplasmin converts iron from its ferrous form into its ferric form, which the body can then insert into the hemoglobin structure. Vitamin A (retinol) is needed to activate copper so it can grab, transform and transport iron to the bone marrow.
In other words, if you’re retinol or copper deficient, you won’t be able to use your iron to make hemoglobin.
Although most people are told they have iron deficiency anemia if they have a low MCV, iron deficiency is most likely not the reason your MCV is low- it’s usually that one or more cofactors (Vitamin A, zinc, B6, copper) depleted. Always check your iron levels before supplementing with iron, because excess iron can be very inflammatory. A good marker to check is ferritin which is a topic for a future post!
What can you do?
As with an elevated MCV, I like to always take a food first approach. After 3-6 months, recheck your MCV since it takes about 3 months for your red blood cells to turnover.
A good food for anyone who is struggling with microcytic anemia is liver, since it has all nutrients necessary for hemoglobin production and is the correct ratio. For those who don’t want to regularly eat liver, you can take freeze dried liver capsules!
Copper is found in shellfish, nuts, sesame, cacao and organ meats, as well as salmon, mushrooms and avocados! 🥑
Zinc is found primarily in seafood, meats like poultry, eggs, dairy and some nuts and seeds 🥩
Some grains and beans also have zinc but they also have anti-nutrients like phytic acid which inhibit it’s absorption, so I would not count on it to achieve the daily amount. If you do choose to eat nuts, seeds, legumes and grains, prepare them properly by soaking and sprouting them prior to consumption!
Vitamin A is best consumed in its active form (retinol) through egg yolk, full fat dairy, butter, cod liver oil, beef liver, and oily fish such as sardines or anchovies 🐠
Betacarotene is a retinol precursor with a pretty low conversion rate, but you may be able to get some retinol precursors from orange and yellow vegetables like carrots and bell peppers 🥕🌶
Vitamin B6 is also found in beef liver and other organs, eggs , seafood, poultry and some leafy greens and walnuts 🍣
Iron comes in 2 forms: heme and non-heme iron. Heme iron is found in meat, fish and eggs and is the bio-available form.
You can also get non-heme iron from plants, but that needs to be converted and ideally consumed with vitamin C to absorb it properly. Sources include beans, spinach, broccoli and nuts, as well as grains that are fortified.
As you can see, most of these nutrients are abundant in animal products, which makes me very hesitant to recommend a vegetarian or even vegan diet.
Below are some recipe ideas to help you get all those nutrients in the yummiest way possible 😋
Egg tart with avocado and sautéed spinach and mushrooms in butter 🧈😋
Steak and eggs with avocado 🥑
Baked avocados with smoked salmon 🍣
Grain free toast with avocado, egg and smoked salmon, or liverwurst 🥪
Steak with roasted carrots and butter 🥩
Grilled salmon with bell pepper hash and guacamole 🍣
Roasted chicken with bell pepper broccoli bake and tahini 🥰
Bison burger with carrot fries 🍟
Chicken kabobs with tahini veggies 🥗
Bell pepper dip or baba ganoush with meatballs or crudités 🥕
Supplements to help:
Again, like with macrocytic red blood cells, I want to encourage a food first approach and a little bit of patience. Due to the time it takes for a red blood cell to mature, it can take 3-6 months before you are changes in the bloodwork. If you are not seeing anything after that, it’s time to dig deeper and consider supplements.
If you’re not sure which nutrient exactly you’re deficient in, I always recommend liver capsules which are natures multivitamin, and supplies you with all the bioavailable nutrients your body needs to create hemoglobin and make red blood cells. My favorite brand is Heart and Soil but any grass fed organ complex will be good!
Another thing that’s a no-brainer to take are trace minerals, which you can add to water to get micro-doses of zinc, copper and other nutrients throughout the day.
For vitamin A, I suggest you take a high quality cod liver oil, such as Rositas, which will also get you in a dose of healthy anti-inflammatory fats! It’s important to supplement with retinol and nothing synthetic.
When supplementing with copper and zinc, I always recommend that you don’t do it for long and check your blood work regularly, since the two antagonize/deplete each other and need to be present in your body in a special ratio. Some people supplement with powdered oyster shell capsules to get their zinc! You can also take a well formulated multi vitamin, such as that from Designs for Health, which contains a good balance of zinc and copper!
Vitamin B6 can be obtained through a well formulated b-complex! I like Biotics for this, since they do not derive their b vitamins from petroleum. Their Bio B complex is a great source of B6, among other b vitamins!
I never suggest that you supplement with iron capsules, since most supplements are just powdered rust…if you have made sure that you have adequate levels of the above nutrients and you still have low iron levels, I would dig deeper and potentially investigate if you have a parasitic infection, as parasites like to eat iron which makes the iron in the body unavailable for the cells.