Health & Nutrition

High RBC, Hgb and Hct

High Red Blood Cell (RBC), Hemoglobin (Hgb), Hematocrit (Hct)

Considering the rarity of primary polycythemia and in the absence of heart and kidney problems as the underlying causes of a secondary polycythemia, specially in a young non-smoker, you can safely assume the high RBD, Hgb and Hct are caused by either or both of the following underlying conditions:

Recommendation for a treatment plan

Also see:

N of 1 – Metabolic Syndrome and Ketogenic Eating
What, Why and How

  • For 2-3 months, do the following:
    • Use a CPAP machine for diagnosed sleep apnea – there are several false negatives, especially with home sleep apnea tests.
    • Learn about inflammation and follow a non-inflammatory diet; avoid lectins (plant-based foods high in lectins like legumes and nightshades), high omega 6 seed/vegetable oils, most packaged processed foods with a list of preservatives, emulsifiers, etc.
    • Avoid high fructose corn syrup in foods and soft drinks and reduce sugary fruits intake
    • Avoid sugars, sugar substitutes, and sweeteners.
    • Eliminate all grains and reduce starchy vegetables
    • Eat real food, whole milk, grass-fed dairy, meats, fish, green vegetables, eggs, etc.
    • Spend time outdoors, get sun as much as possible without wearing sunscreens (just don’t get sunburn)
    • Sleep early and get at least 7 hours of sleep
    • Reduce stress – easier said than done:-)
    • Supplement as needed; vitamin D (optimal: above 40 ng/mL), B12, B3, and magnesium
  • After 2-3 months, get a blood test that includes:
    • CBC panel – recheck RBC, Hgb, and Hct
    • C-reactive protein (CRP), sedimentation rate (ESR) – inflammatory markers
    • Vitamins D & Bs
    • Erythropoietin (EPO) – a hormone made by the kidneys that play a key role in producing red blood cells – is not essential to test for this, most likely not an issue.
    • Lipid panel – ideally show 1:1 triglycerides to HDL. a High level of triglycerides and especially a low HDL (optimal: above 60 mg/dL) is associated with metabolic syndrome. See below for metabolic disease risk, TG: HDL ratio.

Here is a case of a young girl with several inflammatory related conditions and the dietary approach Dr. Mason took to help her:

Dr. Paul Mason tweet


“Polycythemia is a condition that results in an increased level of circulating red blood cells in the bloodstream. People with polycythemia have an increase in hematocrit, hemoglobin, or red blood cell count.” Here is an explanation of polycythemia and its types.

  • There are two categories of polycythemia:
    • Primary or polycythemia vera (PV) resulted from internal problems with the production of red blood cells in the bones. This type is relatively rare. Almost all PV patients have Jak2 (Janus Kinase 2) mutation. Phlebotomy (blood donation) is the usual way of controlling this condition.
    • Secondary polycythemia is caused by other underlying medical conditions. Most polycythemia is secondary.
  • The normal levels for hemoglobin used to be greater than 16.5 g/dL (grams per deciliter) in women and greater than 18.5 g/dl in men. The World Health Organization changed the limits in 2015 to 16.5 g/dl for men and 16 g/dl for women with JAK2 mutation to determine primary polycythemia (polycythemia vera or PV).
  • One of the important enzymes regulating this process is called erythropoietin (Epo). The majority of Epo is produced and released by the kidneys, and a smaller portion is released by the liver


My personal view is that the criteria for polycythemia are arbitrary and an attempt to make sense of another mostly metabolically related disease (possibly autoimmune triggered). Many diseases are on the rise due to dietary and environmental factors.

While these conditions are on the rise, WHO and other health agencies changing the criteria such that more people are diagnosed with diseases that they didn’t have based on the old standards. Some of this may be driven by the pharmaceutical industry that is always ready with the drugs to “help” the newly diagnosed patients!

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