* * * Doctor comment, please: Hemoglobin 13.5 Hematocrit 40.4
- A hematocrit of 40 means that 40% of the volume of blood is composed of red blood cells which is about normal. Most reference ranges for Hct are
[I refer to "The Reykjavik Study: Distribution of Haematological Serum and Urine Values in a General Population of Middle-Aged Men": "2955 males aged 34-61 years were invited for examination during a six month period...(snip) The response was 75% (2203) (snip)... The approximate 5% and 95% centiles were as follows:
Hematocrit: 41% - 49% (age group 35 to 49), 40% - 49% (age group 50 - 59);
Hemoglobin:13.4% - 16.9% (age group 35 to 49), 13.4%-16.8% (age group 50-59)"
By this study, which is the one I used to answer, Bob/Dave's 40.4 is in the bottom 5% percentile. That is anemia, or "pre-anemia". I have put up the tables for you to see them here:
What is more important then just looking at a normal range hematocrit is the MCV, TIBC and Ferritin level.
[What do "MCV" and "TIBC" stand for? - Ellis]
Recombinant Erythropoietin (r-HU-EPO) EPO is an injectable protein hormone that acts on bone marrow to stimulate red blood cell production. The recommended criteria for initiating the prescribed erythropoietin therapy for adult patients is a hematocrit level below 35% or hemoglobin level below 10.
[I understand that I am recommending that he should use EPO long before "the recommended criteria for initiating the prescribed EPO therapy for adult patients," which is horrendously low. I am hoping to avoid the damage to his brain that he will surely suffer for lack of oxygen if he waits until he reaches this extreme. - Ellis]
When an athlete injects EPO (or anyone with a normal h/h), their hematocrit can rise as much as 40%. This results in an especially high concentration of RBCS (red blood cells). The danger sets in when this hematocrit level gets too high. At this point, blood could literally 'clog up' an artery leading to a vascular disaster in the form of a heart attack stroke, cardiac failure, or a condition called pulmonary edema; this is a form of water logging of the lungs because of left ventricular failure. You can most definitely get to much of a good thing.
[This is analogous to getting acromegalia with growth hormone. Of course I was not suggesting he should overdose. Hematocrit rises slowly enough with EPO, and can be easily monitored so that he would not overdose. I am recommending he has to use the right amount of a good thing. You can also get too little of a good thing. - Ellis]
The use of EPO in generally is for chronically ill patients for the most part.
[He is chronically ill. He is not defined as chronically ill, but his condition is going to get worse and worse, unless it is stopped and reversed right now... - Ellis]
When evaluating anemia the first thing that needs to be done is find the underlying cause. In most cases that is loss through the GI tract and this can be checked by a simple stool test for blood. Which if positive a colonscopy should be done unless cause is obvious. Treatment options depends on cause of anemia eg.b12 or folic acid def.,viral induced, drug induced, RBC destruction Iron deficiency anemia: 1) adequate nutrition 2) ferrous gluconate in combination with ascorbate acid (which aids in absorption of iron) but be aware that overloading the body with too much iron dramatically increases risks of cancer, heart disease, and neurological degeneration. So do not routinely takes supplements with iron. Also, the use of testosterone replacement can greatly increase RBC volume this can be used to the advantage of an anemic individual or cause "polycythemia" too much blood and necessitate the need for a therapeutic phlebotomy (donating blood) every few months.
[His testosterone levels are also "low-average," meaning low. I would think he should also try testosterone replacement therapy, in conjunction with EPO. - Ellis]
As for the treament of Crohn's disease with rHGH a landmark study was published in the N Engl J Med. 2000 Jun 1;342(22):1664-6
A preliminary study of growth hormone therapy for Crohn's disease. 37 adults with moderate-to-severe active Crohn's disease to four months of self-administered injections of growth hormone (loading dose, 5 mg per day subcutaneously for one week, followed by a maintenance dose of 1.5 mg per day) or placebo and eat at least 2 g of protein per kilogram of body weight per day. Patients continued to be treated by their usual physicians and to receive other medications for Crohn's disease.
CONCLUSIONS: Our preliminary study suggests that growth hormone may be a beneficial treatment for patients with Crohn's disease. I use rHGH in combination with large dose Glutamine and have found improvement in patients with Inflammatory bowel disease. Healing of intestinal mucosa should reduce amounts of microscopic RBC (Red Blood Cell) loss, thus improve any iron deficiency anemia.
Allyn A. Brizel M.D.
Center for Clinical Age managemnent
[Thank you Dr. Brizel for your post, which generally takes a much more conservative view than I did about EPO, and which is important for Bob/Dave to evaluate.
I am not a doctor, and I don't like to go against what doctors say, especially not doctors who I know are good doctors...
Except in this case we don't agree that his hematocrit levels of 40.4% are "about normal" because we are obviously using different criteria, ie, different reference ranges for hematocrit. We will probably agree after you see the details of the Reykjavik Study, a summary of which I quoted above, and I have put the hemoglobin and hematocrit tables from this study, and another very extensive study of hemoglobin on senior citizens age 70 to 88, on a page of their own, for everybody to study. These tables document the fact that hemoglobin drops drastically after age 60. This has been known for many years, but it has been accepted as "normal", and it has also been accepted as normal that senior citizens become senile... and we don't know why. Now, maybe, we will know one reason why.
I have already sent you (and other doctors on Rejuvenation) the full Reykjavik study and other studies and my report about this by snail-mail, and I have put up a page with the tables of hematocrit and hemoglobin found in that study, and another large study of the hematocrit and hemoglobin of healthy men and women age 70 to 88.
The point I want to make is that EPO is NOT BEING PRESCRIBED by doctors for something that I think IT SHOULD BE PRESCRIBED FOR, the lack of which will result in grave brain damage, as is now considered "normal" in senior citizens. Bob/Dave's case is exactly one of those cases where it should be recommended, according to me. Bob/Dave's case (low and falling hematocrit and hemoglobin) is very common after age 60, and becomes more common after that age, as does loss of memory and cognitive functions.
As you will see on the tables, the AVERAGE hemoglobin after age 70 drops down to about THE BOTTOM 5% or 10% from age 15 to 60. So in order to see what will
happen to senior citizens because their hematocrit and hemoglobin drop, we only
have to study the bottom tail end from age 15 to 60 to see what happens to
them... and that includes less cognitive functions and twice as much cronic diseases... Anemia is also associated with low intelligence, or mental
retardation. I think this shows the reason, or one of the reasons, why senior citizens (me, in a very few years) will lose their cognitive functions!
After age 60 hematocrit and hemoglobin drop, but not enough to notice, from day to day, or even from year to year. From age 60 to 70 it drops only about 1/4 of 1 percent (.0025) per year... but from age 70 on it accelerates to approximately 1/2 percent (.0050) per year. I am sure that beyond age 88 it drops even faster. This is still not enough to notice from day to day, or year to year, but it is enough to notice from decade to decade!
This is further complicated because the volume of blood also decreases with age. It is even further complicated because with advancing age the incidence of diabetes or pre-diabetes also increases greatly, and with it the average level of glucose in the blood increases greatly also. Glucose normally adheres to about 5.5% of hemoglobin in non-diabetic adults, but this increases about 50% or more in pre-diabetic or diabetic adults, to 7%, or 9%, or even higher. (This is revealed through a blood test for "Hb-A1c" where "A1c" is a sub-type of hemoglobin that has glucose attached to it.) Hemoglobin that has been attached to glucose loses much of its ability to deposit oxygen. It is not hemoglobin anymore, it is ex-hemoglobin, for our discussion.
So now we have: less blood volumen, less hemoglobin in that blood volume, and less hemoglobin that can deposit oxygen. This creates a condition of hypoxia (very low or oxygen starvation) in the brain of senior citizens, which might also be complicated by arthritis and hardening of the arteries, which itself might have been caused or complicated by a lack of sufficient oxygen in the blood.
I point out that Dr. Ronald Klatz did NOT mention EPO as one of the anti-aging hormones, or even as one of the hormones that falls with age, in either of his two books "Grow Young With HGH" or "10 Days to a Younger You". I would be surprised if the use of EPO to prevent brain aging has ever been discussed at any anti-aging conference.
A search for "EPO" on www.google.com today showed zero posts related to
the use of EPO to prevent brain damage on senior citizens, or the use of
EPO to increase hemoglobin on anemic patients, or the use of EPO to
increase intelligence, and that discussion group focuses on smart drugs, ie, ways to increase cognitive functions now and to prevent brain aging. I could find NO studies on Medline showing the use of EPO on senior citizens to prevent the loss of cognitive functions, to show one way or the other if I am right, or if I am wrong.
So, I know I am saying is perhaps new, and going against the "common wisdom," but I'm sure I'm right. The cause of senility is lack of oxygen to the
brain, and the solution is EPO, erythropoietin, a hormone that will increase
the amount of red blood cells, and thus hemoglobin, and thus oxygen to the
I hope this discussion will cause some waves to suggest that the use of EPO HAS TO BE studied on senior citizens to prevent loss of memory, or senility. This is the ultimate smart drug, and for me, the ultimate and most important anti-aging hormone, although I won't need it for a while (but I am taking it already... to learn to use it... my hematocrit is UP from 48% to 50.0% and
hemoglobin is now 16.8%.)
Three (new) stars for this post, by Dr. Brizel whose comments are very valuable.
This is an extremely important discussion which I think will affect ALL of us someday, if we live past the age of 60. I hope we all will live to age 100
at least, in a healthy body and with our brains still functioning.
See the hemoglobin and hematocrit tables from the Reykjavik Study and another study of hemoglobin on senior citizens, and a discussion, here :
(links on this page may not work yet.)
Date: Sat Aug 25, 2001 8:26 pm
Subject: Re: [Rejuvenation] Re:* * * Hemoglobin 13.5 Hematocrit 40.4/2
I have crohns disease in the lower intestine w/fistula...
I was operated on 18 yrs. ago about 8 yrs ago i had a flare up
(blockage) no operation they did some kind of stomach clearing with
tube up my nose down to my stomach...
I was put on sulfa and large doses of prendisone for 3 mo. then off the
prendisone and take sulfa (anti inflammatory ) for rest of my life..
I was told by Dr. that because of the operation for crohns i was unable
to absorb nutrients and vits.. he recommended B-12 injections monthly
also ferrous sulfate (iron) 1 gr. daily and that i would be anemic the
rest of my life...
[Yes, and he accepted your disease as "normal"... It may be "normal"
to be anemic if you have those, but that is no excuse for "accepting"
that you should remain sick for the rest of your life. - Ellis]
Hemaglobin.... Hematocit... I have Emphysema W/chronic bronchitis asthma
..I was told with having these conditions it was normal to have low
hematocit, according to my lung specialist dr.
I just got my new AAMD while I was having a very severe bronchitis attack
[I'm glad you did, because it sounds like your lung "specialist" would
have been content to let you die soon. - Ellis]
..My lung MD put me on a lot of antiinflamatory drugs decongestants
for almost 10 wks. I could not continue my every day work or exercise...
things looked grim.. as a last resort I called my aamd ..He told me to take
1000 mg of GOLDENSEAL ROOT..
sunofagun! if it didn't work... cleared up the mucous in 5 days
full recovery in 12 days...
He did the same when I had shingles.. both lung and shingles at the
same time... he had me take 2000 mg lysine for shingles
same results 4-5 days and it was over..
i had both lung and shingles for 9 wks before i asked my new aamd for help...
He told me to tackle my illnesses one step at a time... No. 1 hgh 1 un.
every other day...
I posted my protocol in last post.. I printed your advice and I am going to
show it to him... he is a very very open dr. easy to talk to...
After being on hgh 1 wk (injections) i got on my tread mill for 30 minutes
at 3 mph and 15 minutes on stationary bike (piece of cake)...2 wks ago I
thought I had had it... no energy... congested lungs...
Thank God I found this great group of people...I thank you all.. especially
to Ellis, Gordon, Whooo and others whose names I can't remember (can't remember
mmmm I think I just read that some where... symptoms... mama mia!)