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I'm anemic, but have good iron and B12 levels. Any ideas?

I've been following a lfrv diet for 4 years now and I never got my blood tested until last September. I discovered my RBC's, hemoglobin, and hematocrit were low, but my iron was good. Since my B12 was also on the low end I started taking shots and when I got my second tests done in December, my RBC's and hemoglobin went up a bit. I got tested again yesterday and my RBC's and hemoglobin dove down again. I have no idea what the issue could be if my iron and B12 levels are fine. Does anybody have any ideas or advice? I'll post screenshots of my tests down below.

First test: Sept 2014

Second test: December 2014

Third test: March 2015

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Was the ferritin test the only measure of your iron levels? Really you need a transferrin saturation test to rule out iron deficiency. 

Some people just have slightly low Hb and Ht naturally. Without older results to compare to it's impossible to say how low your recent results are. My Ht has always been around 38% since I was a kid.

Do you have any symptoms of anemia? 

Yea I've read about transferrin so I might get that tested next. 

On top of the low Hb and Ht though I have low RBC's and do have some symptoms of anemia. For example, walking up hills causes me to breathe a bit harder to where it's hard to talk and I become quite tired in the evenings even though I sleep 9-10 hours/night. 

I got transferrin tested and it's solid. Right now I'm just waiting on the rest of my results. I'll post the results when I get them all. 

Do you track your calories on a site like www.cronometer.com or www.nutritiondata.com?  

I know nutritiondata shows daily iron consumption.  

Natural sources of iron are better than synthetics, so may be tweak your diet to make sure you get a little bit more.  

Do you eat 1/2-2 heads or more of lettuce greens daily?  About 1-2 oz of nuts or seeds?  Get 3000 plus calories a day?

I am not sure if you are RT4 or high raw, but also, try getting more calories from raw fruits, lettuce greens, and nuts and seeds.  Some of the cooked foods we eat like grains and potatoes often have antinutrients like oxalate  acid that can interfere with iron absorption.  


Also, hydration is important, but be careful not to overhydrate.  Drink what you need until urine is light yellow, but then stop.  Drinking too much can cause us to lose some nutrients.  


Your results simply look on the low end of normal, so I would not panic yet, but continue to test and monitor with your doctor to rule out any other causes.  

Good luck and Peace, PK

I think you misread my post. First, I state right in the title that my iron levels aren't the issue and it is also shown in my test results that I posted. Also, you asked if I'm RT4 or high raw but in my post I said I've been raw for 4 years.  


Actually, I do like to double check what people are currently eating.  I would not have to do this if we were roommates of course, but since I do not know you personally, I prefer to ask.  We probably have 5k different takes on what it means to eat raw or RT4.  As humorous as this sounds, I have been told things before like "I am low fat raw until dinner when I eat ice cream LOL.  

I do have a roadmap in my head when it comes to nutrition.  Sometimes, if we have a condition we were not born with, it is often related to diet.  

I am going to assume you are 100% raw now.  The next question would be, do you eat things like kale, chard and spinach?  And I am going to work up to my point of why I am asking.  


You mentioned to Nathan your tansferrin was tested and I assume good.  I did not know this at the time I answered your post.   

It was in my mind that while your blood results of ferritin were normal, you may still have had a tissue uptake or storage problem with iron or a possible liver issue.  But this seems to not to be the case.  Since I was not clear on that initially, that is why I still promoted eating iron rich foods. You still might consider having your gallbladder health and function tested.   


The next thing you told Nathan was:

 For example, walking up hills causes me to breathe a bit harder to where it's hard to talk and I become quite tired in the evenings even though I sleep 9-10 hours/night. 

This is where bloodwork can be tricky.  You are slightly anemic, but your blood results might be normal for long term (raw) vegans who are not full of animal products.  Most research and averages we base lab results on are based on what is normal for SAD or meat eaters.  So if someone is slightly off on something,   and not having other symptoms, I might advise a wait and see approach.  

Raw vegans eating a diet high in fruit may also test low because the soluble fiber in fruit will draw bile, bilirubin, and toxins from liver out of the body in the stool verses other diets which may allow these things to be reabsorbed.  

However, since you are having problems, I might have some more suggestions.  

Your shortness of breath may be related to the anemia, but it could have other causes, perhaps multiple causes.  For example, foods high in oxlate acid like spinach, kale, and chard, could cause both anemia and shortness of breath, and all kinds of medical issues.  


So from a nutritional point of view, I would recommend avoid the high oxalate foods I have mentioned in the blogpost for a few months and see if you feel better.  

Get your greens from lettuce greens, and about 1/2-2 heads a day.  

The next issues regarding any shortness of breath, possible cramping, possible dizziness, and other symptoms that come with that could be body fat % that is too low or dietary fat that is too low.  

Many nutrients we consume are fat soluble, and we need both dietary fats and body fats for absorption, regulation, and storage of these nutrients.  It starts with diet.  I would recommend, if you do not already, to eat fat% of calories at 10%+ for a while, and to get about 1-3 oz of nuts or seeds daily, or mix it up with an avocado.  This should be everyday.  

Nuts, seeds, and avocadoes may be higher in fat soluble nutrients like vitamin E and K.  

I do not know how much training you do, but recommend, at least for the next few months, do not overtain.  Let your body rest and repair itself.  Sure, walk and resist gravity about 30 minutes a day, but now may not be the time to add olympic style training to the menu until you rule out major health issues, and you heal more.  

While some bodybuilders may keep a body fat % at 2-4% temporarily when they are in peak competitive mode, they often have to resort to unsustainable or unhealthy practices to do so, or can only sustain this for a short time before health problems start.  Body fat survival, the minimum to stay alive for males is about 4-6%, with ideal long term healthy ranges for males of all backgrounds to be within 6-17% or even slightly higher.  

I know many of us have ideal weights, looks, and body fat% we aim for, but if it is making us sick, it is not worth the price.  

I do not know your body fat % of course, but do recommend you analyze this and perhaps consider a slightly high fat % for your health.  There is always a so called Goldilocks zone.  Of course, too high and we get sick, have inflammation, messed up hormones, etc, but going too low is not good either.  


As I mentioned before, keep testing with doctor.  There are other issues that could cause anemia too.  Have you had extensive kidney testing?  Been to a nephrourologists?  How is your liver?  Have you ever had childhood illness, blood diseases, or cancers that might resurface?  Get checked out for bone diseases, lymphomas, and other blood diseases too.  

Overall, based on blood tests alone, I am not too worried.  Small tweaks to dieatary and lifestyle changes may be all it takes.  It even seems there were small improvements between first and second test, so it seems you may already be making adjustments that are right for you.  

For more ideas on anemia and possible causes, and or recommended testing,  here are some links...




Peace, PK

Thanks for the lengthy response. Yes I'm 100% raw lfrv, 80/10/10, whatever you want to call it. I do eat spinach and whatnot, but the vast majority of my greens are lettuce. I eat 2+ heads nearly every day. 

For the last little while I've been eating a bit more fat (avocado, hemp seeds, chia seeds) nearly every day bringing me up to about 10% cals from fat, so maybe I should keep that up for a while and see if there are improvements as you mentioned and maybe even increase those a bit. I do have a low bf%, but never had a dexascan. All the tests I have done have shown about 6% though. 

You also mentioned overtraining. I train about 5-6 days/week so might reduce that as well as you mentioned for the time being to rest and recover. 

Anyways, I posted the rest of my results down below and my blood tests look good besides the rbc/hemoglobin numbers so I think I'll just wait for now and retest a few months down the line. 

Matt, it is possible that you have thalassemia minor. I have it. My dad had it, and my sister had it. My doctors can look at my blood tests and tell. I will never be an athlete but I can do free weights at the gym and I can at least look like an athlete!

Ya I'm wondering about htat. I got more tests done (including tests for thalassemia) so waiting on those results right now. I'll post the results when I get them.

Pete Sampras and Zinedine Zidane have thalassemia minor...

If you inject with cyano- or hydroxocobalamin in stead of methyl- or adenosylcobalamin, maybe do a active b12 test or a mma test to make sure that the cyano/hydroxocobalamin is being converted to active forms.

You could also do the test suggested by nathan, but based on what i fill in on cronometer i don't understand how a male could not get enough iron, unless there's an absorbtion problem.

THanks but I do methyl injections. 

Also, it's not an iron issue as is shown in my ferritin results. THat's what makes it more complicated in my case. Also, I just got iron saturation/transferring and whatnot checked and it's also good.



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