What many people know is that iron deficiency can lead to your red blood cells getting too small causing anemia. What many people don’t know is that B6 can do the exact same thing!
So how do you tell if the cause of your small red blood cells is due to low iron, low B6, or both?
The answer lies in cross referencing other lab values on your blood test. Bloodwork is a lot like a game of chess, each marker has its own pattern and contribution, just like each chess piece has their own movement. Learning to interpret blood work is like learning how to play chess, as we start to understand the individual movements of each value, we become a much more skilled player. We learn to predict the culprits, outcomes, and shifts; much as the chess master can predict and calculate their opponents next move. It’s all about looking for clues and the more evidence you gather, the more likely you are to correctly zone in on the root cause of your issue. Time to play chess!
When you are anemic you will see a few things in your red blood cells.
For an iron and/or B6 deficiency anemia, you may see a low MCV (Mean Corpuscular Volume) under 84 fL. We talk about identifying this here: Goldilocks and the Three Red Blood Cells
You may also see low hemoglobin (HGB) on your blood work with an iron and/or B6 deficiency anemia because both are important in hemoglobin synthesis.
Therefore when you find low hemoglobin and low MCV on your bloodwork, there are a few markers we can look at to tell us who the culprit is, iron, B6, or both.
You may have symptoms of iron deficiency such as unusual fatigue, paleness, headaches, dizziness, shortness of breath, heart palpitations, restless legs, hormone imbalances, weak muscles, poor sleep, dry and damaged skin, spoon shaped fingernails, and/or a swollen or sore tongue.
In your blood work, you will see something low in some or all of these iron related blood measures (refer to the end of this article for high performance values):
But if all these measures are normal, you may have a vitamin B6 anemia!
You may have symptoms of B6 deficiency such as dermatitis (skin inflammation), muscle pain, glossitis (a sore glossy tongue), depression, anxiety, confusion, PMS symptoms, cracked and sore lips, get frequent infections, low energy, and tingling and pain in your hands.
Another interesting thing you may experience with a B6 deficiency is suddenly falling off in a workout about ⅔ of the way through even though you don’t feel tired. It’s almost like you’ve hit an invisible wall, but not like the wall you hit in say a marathon where you feel completely spent, feel out of energy, and like you gave it everything you got. This wall is different, you feel like you have the energy to go, but you just can’t. This is because B6 helps run your energy production cycle, the Kreb Cycle, and without B6 your energy production will come to a grinding halt. It also helps release stored glycogen in the muscle to support endurance and without B6 we can’t access the store fuel in our muscles
To catch a B6 deficiency in your blood work, you will see something out of range in some or all of these vitamin B6 related measures:
Homocysteine is a really great value to check in athletes. This test is not commonly run on routine blood tests, but it is something that we include on our athlete blood panels. You may have to ask your doctor to get this one added. The reason we always run it on our athletes is because homocysteine is a metabolic byproduct that can affect your heart, vascular, and bone health. If homocysteine is chronically high, you run the risk of inflamed blood vessels, low bone density, bone fractures, and heart attack. When it is high, it usually means that your body does not have enough vitamin B6, vitamin B12, and/or folate to healthfully process the homocysteine out of your system. And with the increased demand for B vitamins during training, these stores can get depleted easily! So if your red blood cells are small, your serum iron and ferritin are in range, BUT your homocysteine is high....then B6 is a likely culprit!!!
ALT, AST, and LDH are also B6 dependent enzymes. When these values go low, there is more evidence to support a B6 deficiency.
Now, if you have low iron related blood measures AND low vitamin B6 related blood measures, then it would be a good idea to supplement with them both.
If you are low in iron, our favorite forms of iron are iron aspartate and iron glycinate because they use an amino acid transporter to increase absorption. And remember, amino acids are the building blocks of protein and life!
To boost iron levels, it can also be helpful cooking with a cast iron skillet or eating foods high in iron such as liver, grass-fed beef, white beans, lentils, spinach, kidney beans, chickpeas, duck, sardines, lamb, blackstrap molasses, and pumpkin seeds.
If you are low in B6, our favorite form of this vitamin is the activated form called pyridoxal-5-phosphate. This is the form we chose to have in our Paleo Energy Power Packs. We prefer the activated form so your body doesn't have to spend any energy or nutrition to activate it, it is active and ready to go!
It’s also important to eat foods high in B6 such as turkey, beef, pistachios, tuna, pinto beans, avocado, chicken breast, blackstrap molasses, sunflower seeds, sesame seeds.
If your red blood cells are small (low MCV), make sure to play a little detective work because it could be stemming from and iron OR vitamin B6 deficiency OR both!
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