Q: I am having knee pain (both knees) for last six months. My complete blood count (CBC) shows haemoglobin as 17 g/dl. Does this have any implications? The arthritis test is negative. The knee x-ray is normal. What type of foods I should avoid? Kindly advise.

A:The number of red cells normally present varies according to a persons age and sex. Men have higher results than women do and newborn babies have higher values than adults. The presence of an elevated red cell count is called erythrocytosis or a polycythaemia. This increase in red cells may show in a blood test result as an increase in red cell number, or as a rise in haemoglobin, or packed cell volume. Red blood cell production is governed by a hormone called erythropoietin (EPO) that is secreted by the kidney. Erythrocytosis is not a disease but is usually part of some other problem. There are no specific symptoms or physical signs although the underlying disease may cause the patient to seek medical help. Many times, the high hematocrit is noticed when a person has a blood count done as part of an exam for an unrelated complaint. The normal haemoglobin value in an adult male can range upto 18 g/dl. It can be raised due to many reasons and these causes may be subdivided into whether there is: a) a true or absolute erythrocytosis (polycythemia) due to an increase in red cells or b) an apparent or secondary erythrocytosis when the red cells are not increased but are instead more concentrated. The secondary increase can be due to dehydration, diuretic drugs, burns, stress, or high blood pressure. The usual investigations undertaken include a complete blood count with peripheral smear examination, estimation of arterial oxygen saturation, serum erythropoietin level and red cell mass (rarely done) and a bone marrow examination. A hematologic consultation would allay youe apprehensions and also exclude the possibility of a primary hematologic disorder. The knee pain could be due to any number of causes but as the X-ray is normal many conditions get ruled out. There is no single test for arthritis but a number of different markers are tested in the blood. Please consult a rheumatologist for this. Please eat a normal well-balanced nutritious diet. There is no food item that you need to avoid. Also add 45 minutes of brisk walking thrice a week into your schedule.