DEAR DR. ROACH: I am 90 years old and in good health. I recently saw my doctor and had abnormal blood test results. My white cell count was 2.1, my hemoglobin 9.5 and my hematocrit was 29 percent. Is there any kind of vitamin or food I can take to raise these levels? -- M.A.
ANSWER: Both your white blood cells and red blood cells are abnormally low. Before prescribing a course of treatment, such as a vitamin or special diet, it’s critical to find out why these counts are low. I don’t have enough information to narrow down a long list of possibilities, but I can outline the approach doctors generally take when considering this condition.
I would first want to know the results of your platelet count. I expect that it will be low, in which case the condition goes by the general name of “pancytopenia,” which just means “all the blood cells are low.” While it is true that some nutritional deficiencies can cause this (vitamins B-12 and folic acid, and the mineral copper are the most common), there are many other causes that are more common. Since all of these cells are produced in the bone marrow, a marrow biopsy sometimes is necessary. However, long before that point, a hematologist (blood specialist) will do a complete history and exam, and will look personally at your blood sample for signs of infection, immune system diseases, medication side effects and primary bone marrow diseases that can cause this problem.
Some of the causes are serious and benefit from early intervention, so I would recommend seeing a specialist about this soon. Age makes some conditions much more likely. In a 20-year-old with this, I would think about Epstein-Barr virus (the cause of infectious mononucleosis), but at age 90, I’d be concerned about the myelodysplastic syndromes. Please let me know what you find out.
DEAR DR. ROACH: I exercise six days per week (I’m 67). Frequently, the topic of measuring hydration comes up with different workout pals. I’ve read that coffee and tea count because, even though there is caffeine, there is water. A woman I know says that she subtracts any water with caffeine (coffee or tea) because of the caffeine. When I broached this subject with my daughter, who is an emergency-room nurse, she said that she once worked with a doctor who indicated you have to subtract double the quantity of the caffeinated beverages to accurately account for the water you lose due to caffeine. I have only one or two cups per day, but I want to make sure I’m properly hydrated. I would love your advice. -- D.T.
ANSWER: The very first time that people take caffeine, there is a mild diuretic effect: More fluid comes out of your body than goes into it. However, the kidneys rapidly get accustomed to this effect, so regular drinkers of caffeinated beverages like coffee and tea do not have any diuretic effect from continued use of caffeine. This has been studied in volunteers many times, and I assure you that the myth of caffeinated beverages not being a hydration source is false, although many, including some medical professionals, believe the myth.
Consequently, coffee and tea count toward hydration. However, your body has a perfectly good mechanism for telling you when you need fluid: thirst. Unless you are very sensitive to low fluid balance (many people with heart problems are, and some healthy older people), are very active or are in a hot or dry environment, you can rely on thirst to tell you when to take more fluid.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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