Anemia may be the root cause of many chronic conditions such as headache, migraine, mood disorders, and fatigue. Getting assessed by a functional medicine provider trained in the diagnosis and treatment of anemia may be the missing link towards optimal health. In this blog post I will be focusing on iron deficiency anemia as it is the most prevalent in our clinical practice. While both males and females can be affected by anemia, females are affected at a much higher rate.
What is anemia?
Anemia is defined as a low red blood cell count (RBC), low hemoglobin (Hgb), and a low hematocrit (red blood cell concentration in whole blood). Iron deficiency anemia, or IDA, is defined as a microcytic, hypochromic anemia, where the red blood cells are small in size and pale in color due to poor hemoglobin concentration. These red blood cells do not carry oxygen as efficiently, and your tissues can become hypoxic or starved of oxygen. As a result, your heart pumps faster to try and bring more oxygen to the tissues. Additionally, your brain gets less oxygen which causes headaches and mental fatigue. Symptoms of anemia include fatigue, cold hands/feet, rapid or irregular heart rate, headaches, dizziness and lightheadedness, pale or yellow skin, and shortness of breath. When iron status is addressed, we have seen issues like anxiety, depression, and insomnia improve drastically in our patients.
There are many types of anemias that can affect the body. For instance, Vitamin B12 (cobalamin) and Vitamin B9 (folate) deficiencies can cause anemia. These anemias will present as a ‘macrocytic’ anemia where red blood count is low and the red blood cells actually become larger as part of the deficiency. When assessing your bloodwork for anemia and any other condition, make sure to consult with a physician trained in functional medicine.
How do you measure it?
To assess iron status, we order a simple test called plasma ferritin. Ferritin is your body’s storage form of iron and is in largest concentration in your liver, spleen, and bone marrow. Small amounts of ferritin circulate in your bloodstream in direct proportion to the amount of ferritin stored in tissues. Normal values for ferritin vary with age and sex, and good laboratories will provide age and sex specific reference ranges. The lab reference ranges for ferritin are typically quite large, e.g. 16-154 ng/ mL for a 40 year old female, meaning stricter ‘functional ranges’ need to be used for clinical decision making. Using functional medicine standards, we prefer to see ferritin levels above 100 ng/ mL. It’s important to note too much iron is also a problem, and can cause conditions such as iron overload or hemochromatosis.
What to do:
If your ferritin levels are low, look to optimize digestion of iron by taking a hydrochloric acid supplement which will help increase the acidity of your gut. Having an appropriately low stomach pH (more acidic) is necessary for the proper digestion of iron, vitamin B12, calcium, and magnesium among other vital nutrients. For more information, refer to my blog post on stomach acid and digestion here.
To improve iron status it’s important to consume foods high in iron. Animal protein is one of the best ways to get iron. Red meat, organ meats, shellfish, and turkey are excellent ways to increase iron status when paired with optimal digestion. Cooking daily with a cast iron skillet is another easy way to improve iron status. One of my favorite iron and vitamin B12 rich meals is a grass fed ribeye steak cooked with butter or coconut oil in a cast iron skillet. Another option is to use an ‘iron fish’ which can be dropped into warm beverages and will safely release iron into your drink. Consider using an iron fish in hot water with honey and apple cider vinegar. The apple cider vinegar will help increase gut acidity and improve iron absorption.
If you can relate to the symptoms described above, make sure to get a ferritin and complete blood count (CBC) test as soon as possible from your doctor. It’s always better to ‘test rather than guess’ because too much iron can also be problematic. The tests are simple and inexpensive so don’t hesitate to ask your doctor to order it for you. Having healthy red blood cells is essential for optimal health, and a CBC test looking at iron levels will help determine what steps you may need to take to improve your overall well-being.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
The standard lipid panel consists of four different numbers – total cholesterol, LDL, HDL, and triglycerides. LDL and HDL refer to ‘low density lipoprotein’ and ‘high density lipoprotein’ respectively. LDL and HDL are the carrier proteins for cholesterol in the body and help to make sure the fat from our diets ends up in the cells needing the energy. Triglycerides are fat molecules circulating in the bloodstream. When triglycerides in the bloodstream are abnormally elevated due to poor diet, obesity, or type 2 diabetes, there is more deposition of fat in the tissues leading to weight gain. Total cholesterol is the sum of LDL, HDL and 20% of your triglyceride level. Looking at the values of these different numbers can give valuable clues into heart disease risk and overall metabolic health.
When assessing a lipid panel, I like to use the numbers offered by functional medicine practitioner, Dr. Catherine Shanahan, M.D. in her excellent book, Deep Nutrition: Why Your Genes Need Traditional Foods. She suggests the following optimal lab values for the standard lipid panel:
-Triglycerides less than 150.
-HDL greater than 45 in men and greater than 50 in women.
-LDL: HDL ratio less than 3 to 1.
A high total cholesterol is not concerning if the ratio of LDL to HDL is maintained below 3. Likewise, a high LDL number does not necessarily indicate an increased risk of heart disease if the ratio is maintained. It’s important to remember the gold standard test to determine the health of your lipid cycle is the LDL particle size count. The test assesses for damage to LDL particles – a damaged LDL particle is a smaller one. Damaged LDL particles are more likely to cause inflammatory reactions in the arterial walls leading to plaque formation and atherosclerosis. The LDL particle size count is rarely ordered by physicians due to the cost, however it remains the best test for assessing heart disease risk.
Many physicians put their patients on a class of drugs called a statin which decreases the body’s natural production of cholesterol, especially the type of cholesterol bound to LDL particles. The problem with this is cholesterol is an important building block for many cells in the body including our steroid hormones which include testosterone, estrogen, and cortisol among others. Additionally, the brain contains the highest amount of cholesterol on the body, meaning lowering cholesterol with a statin drug may impair brain function and induce cognitive decline. Statins come with a host of side effects including muscle aches and pains, altered liver enzymes due to liver damage, and increased risk of developing type 2 diabetes. This is why it is so important to match your most recent lipid panel up with the numbers I give above before agreeing to start taking a statin drug. In future posts I will explain some of the diet and lifestyle factors you can adopt to help normalize the levels in your lipid panel without having to take a statin drug.
Post written by Dr. Riley Kulm, DC. Check out his bio here.
Treat Yourself Like a Professional Athlete Part 4: Utilize Conservative Health Care
Elite athletes are utilizing complementary and alternative health care providers more than ever. They understand the key to career longevity is receiving preventative treatments before injuries and sickness occur. Practitioners of complementary and alternative, or ‘conservative’ health care pride themselves on treating the root cause of injury and illness, rather than just treating symptoms. Conservative health care providers aim to use surgery and drugs as a last resort, and only when the athlete has failed to respond to all conservative care treatments.
Who are the complementary and alternative health care providers?
Professional athletes are regularly receiving treatments from Doctors of Chiropractic (DC), Doctors of Physical Therapy (DPT), Licensed Acupuncturists (Lac), Doctors of Oriental Medicine (DOM), Registered Dietitians (RD), Medical Doctors with a focus in functional medicine (MD), and Doctors of Naturopathic Medicine (NDs). Many professional teams employ or subcontract with these various practitioners. Most of these practitioners receive 4+ years of additional education after their undergraduate studies to learn the skills of their given professions and often take similar courses as Medical Doctors (MDs). For example, a Doctor of Chiropractic (DC) or Doctor of Naturopathic Medicine (ND) take many of the same science, pathology, and radiology courses as MDs.
What treatments do complementary and alternative health care providers provide?
Doctors of Chiropractic (DC) and Doctors of Physical Therapy (DPT) are best known for hands on treatments, such as joint manipulations, soft tissue treatments on muscles, tendons, and ligaments, and prescribing exercise therapies to correct faulty movement patterns. Licensed Acupuncturists (Lac) and Doctors of Oriental Medicine (DOM) utilize principles of Traditional Chinese Medicine (TCM) to treat a wide variety of pain syndromes, metabolic and hormonal issues, and other inflammatory conditions that may be hampering athletic performance. These doctors use treatments such as cupping, herbs, ‘Tui Na’ Chinese massage, movement therapies like Tai Chi and Qi Gong, diet and lifestyle modification, and acupuncture. Acupuncture is the application of small needles at areas on the body along specific ‘meridians’ that correspond to areas of pain.
For those athletes seeking more of a Western medicine approach, a Registered Dietitian (RD) or Medical Doctor (MD) focusing on functional medicine, are both great options. The RD will create customized dietary and supplement plans for athletes based on the unique metabolic needs of their sport. The MD focusing on functional medicine will order comprehensive blood, stool, urinary, food sensitivity, micronutrient, and environmental toxicity tests to look for specific underlying causes of metabolic, digestive, and hormonal issues.
How many athletes utilize complementary and alternative health care providers?
Focusing on chiropractic in professional and olympic sports, today all 32 NFL teams and 93% of MLB teams have a chiropractor on staff, and 72% of PGA golfers receive regular chiropractic care. Globally, 90% of all world-class athletes utilize chiropractic care to enhance performance 2.
Dr. Michael Reed, DC was the first chiropractor to act as Medical Director for Team USA at the 2010 Winter Games in Vancouver 1. At the 2012 Summer Olympics, Dr. William Moreau, DC served as Medical Director for Team USA, and an additional 40 chiropractors were on site to treat the US team and athletes from other countries 3. Similar statistics for other alternative health care providers show the mainstream inclusion of their professions into elite level sports.
Which provider should I see?
For athletic injury recovery and functional movement analysis, Chiropractors (DC) and Physical Therapists (DPT) are your best choice. These practitioners are experts at human movement and can identify which movement deficiencies you may have that are predisposing you to injury. Look for practitioners who have the following certifications or coursework: Dynamic Neuromuscular Stabilization (DNS), Functional Movement Systems (FMS), Selective Functional Movement Assessment (SFMA), Global Rehabilitation and Injury Prevention (GRIP), or any practitioner who holds a Certified Strength and Conditioning Specialist (CSCS) certification. As movement experts, chiropractors and PTs identify limitations in joint ranges of motion, stability, and muscle firing patterns that are currently causing or may eventually lead to injury.
For sports nutrition, Registered Dietitians (RD) with a focus in sports nutrition and Doctors of Naturopathic Medicine (ND) will be your best option. These practitioners understand there are unique energy requirements for each athlete and can help you find out what works best for you. Nutrition is key for both recovery and performance, so finding a practitioner well versed in nutrition is imperative.
For digestive issues impairing sports performance and overall health and well-being seek out Doctors of Naturopathic Medicine (ND), Doctors of Oriental Medicine (DOM), or Medical Doctors (MD) with a focus in functional medicine. The MD focusing on functional medicine will order comprehensive tests to assess the health of your gut microbiome, determine if parasites are present and effecting your gastrointestinal tract, and assess how well your body is metabolizing the foods you consume. Functional medicine embodies the idea of treating the root cause of a patient’s problem, rather than just treating symptoms.
When it comes to pain syndromes and injury your best choices are Doctors of Chiropractic (DC), Doctors of Physical Therapy (DPT), and Licensed Acupuncturists (Lac). As stated previously, acupuncturists use needle point stimulation to decrease pain along meridian lines throughout the body. DC’s and DPT’s utilize a variety of manual therapy and joint manipulation techniques to decrease pain and inflammation, accelerating the healing process.
Post written by Dr. Riley Kulm, DC MS. Check out his bio here.
- Mike Reed. 27 April, 2014. In Wikichiro. Retrieved October 24, 2018 from, http://wikichiro.org/en/index.php?title=Mike_Reed.
- Sports Chiropractic: A Winning Solution For Athletes. Infographic (2016). Palmer College of Chiropractic. Retrieved from: https://www.palmer.edu/uploadedFiles/_Resource_Center/Infographics/infographic-sports-chiropractic-.pdf. On October 2, 2018
- William Moreau. 16 June, 2014. In Wikichiro. Retrieved October 15, 2018 from, http://wikichiro.org/en/index.php?title=William_Moreau