Rouleau is French for “rolls”. The term has been derived from the appearance of the RBCs in this condition. Strings of overlapping RBC’s. RBC’s stacked on top of one another (above left). Normal RBC’s on the right.



♦ Digestive Imbalance / Intestinal Stress
♦ This is the worst stage of protein linkage and indicates hyperviscosity (“thick blood”). This stems from either excess dietary protein or from an under-active exocrine pancreas (low proteolytic enzyme production).
♦ Irritable bowel syndrome, colitis.
♦ Eating the wrong foods for the blood type, e.g. wheat consumption by type O’s, beef consumption by type A’s, etc.  
♦ Food sensitivities.
♦ Intestinal dysbiosis (deficient probiotic bacteria).  
♦ Can be an indication of severe degenerative disease.  
♦ Other causes may include: stress, coffee, cigarettes, carbonated caffeinated drinks, excess meat and refined sugar.  
♦ Zeta potential may be off (inflammation, over-acidity and increased protein level in blood).
♦ Dehydration, not drinking enough water.  

Associated Symptoms:

♦ Poor appetite or a heavy/bloated sensation after eating or getting full very quickly.  
♦ Heartburn, indigestion or reflux after eating.  
♦ Abdominal discomfort, bloating, flatulence, especially getting worse during the course of the day.  
♦ Constipation / diarrhoea.
♦ Patients with significant rouleau usually complain of fatigue, shortness of breath and signs poor circulation (cold hands and feet, tingling or numbness). This is because the RBCs ability to pass through the tiny capillaries in single file is severely compromised when they are stacked on top of each other. The available surface area for the exchange of gases is also significantly reduced.  
Pleomorphic Perspective: 

The primary parasitic element of the blood, the endobiont, in its many different forms, possesses an inherent urge to merge. When red blood cells become infested with the higher valence growth forms of the primary parasite, their urge to merge pulls the RBCs together. Copulation between high valence microorganisms on adjacent RBC membranes account for the rouleau formations.

Rouleau is known to be associated with increased ESR, which correlates with hyperviscosity of the blood. Mucor racemosus Fresen is known as the congester as its pathogenic growth forms increase blood viscosity and coagulation.
When the RBCs are stuck together the indentations provide an undisturbed environment and nutritional reserves for the upward development of the endobient.

The valence of the microorganisms can be determined by pressing lightly on the cover slip with a pointed object like the tip of a pen. This pressurization of the sample will break up the RBCs and release higher growth forms hidden in and on the cells.   
Medical Perspective:

Peripheral blood smears display rouleau when factors that increase ESR (erythrocyte sedimentation rate) are present. The ESR is increased by any cause or focus of inflammation and is therefore regarded as a non-specific indication of inflammation.  
The ESR is governed by the balance between pro-sedimentation factors (mainly fibrinogen) and those factors resisting sedimentation, namely the negative charge of the erythrocytes (zeta potential). When an inflammatory process is present, the increase in fibrinogen, α-globulins, and/or β-globulins in the blood causes red blood cells to stick to each other by interacting with the sialic acid on the RBC surface.


The red cells form stacks called ‘rouleau’ that settle faster.  
The presence of massive rouleau can be detrimental to patients suffering from occlusive vascular diseases as it causes impairment of blood flow in the small vessels that can compromise the red blood cells’ ability to exchange carbon dioxide and oxygen gases. This results in localized hypoxia and acidosis as well as generalized fatigue and less than optimum performance.
Rouleau formation plays a specific role in the pathogenesis of some disease. Plasma fibrinogen and Immunoglobulins are some of the potent rouleau-inducing agents. Some industrial poisons such as benzene, parathion & carbon tetrachloride not only increase this phenomenon but also cause thrombotic and hemorrhagic manifestations as well.

Patients suffering from allergies, infections and severe trauma may exhibit rouleau.


Anemia, by increasing the ratio of RBCs to plasma, increases rouleau formation and accelerates sedimentation. Rouleau formation can also occur in association with some lymphoproliferative disorders in which one or more immunoglobulins are secreted in high amounts. Rouleau formation can, however, be a normal physiological finding in horses, cats and pigs.
Rouleau of erythrocytes is related to very high serum protein concentrations, generally due to multiple myeloma or to macroglobulinemia. It is also frequently found in many disease states ranging from arthritis, diabetes, myocardial infarction and in patients with increased alcohol intake.  

♦ Reduce intake of dietary animal protein to 1g per kg body weight per day (e.g.: a 70kg adult should not exceed 70g animal protein daily).
♦ Do not consume animal protein and simple starch in the same meal.
♦ Eat meals while sitting down, do not rush while eating – remember to chew properly.
♦ Follow the diet relevant to the blood type.
♦ Identify and avoid hidden food sensitivities.  
♦ Avoid caffeine, stop smoking.
♦ Test and correct Homocysteine.
♦ Increase water intake. To determine necessary daily water intake (in litres): (Weight in kg ÷ 8) x 0.25. 

A combination of the following:

♦ Digestive enzymes Digestive enzymes Digestive enzymes Digestive enzymes  taken with main meals.  
♦ Betaine Hydrochloride with Pepsin with meals.
♦ Probiotic supplement Probiotic supplement Probiotic supplement Probiotic supplement.
♦ Herbal bitters (e.g. Gentiana) taken before meals. The following is a very effective formula to stimulate digestive enzyme, bile and HCl secretion:  
Gentian, Calamus, Dandelion, Centaury, Aniseed, Mugwort and Licorice.  
♦ TCM: Si Jun Zi Tang, Bao He Wan, or other digestive formula appropriate to the pattern present in the case.
♦ Vitamin B3, as non-flush Niacin (1000mg daily). Niacin helps to remove excess protein and saturated fat from the blood and stimulates hydrochloric acid production by the stomach.
♦ Trace minerals.     
♦ SANUM: Fortakehl, followed by Mucokehl.  


Copyright Dr Okker R. Botha, Johannesburg, South Africa, 2009