Micronutrient And Nutrient Deficiency Testing

How do I know what vitamin deficiencies I have? How do I measure my vitamin and nutrient levels? These were questions I asked myself when I was trying to feel less fatigued just few years ago.

I embarked on a mission to discover a comprehensive test that could look inside my cells and tell me exactly what I should replace with diet and some targeted nutrients.

The Genova NutrEval test with 125 different metabolic measurements became my favorite test both for me and my patients. It measures vitamins, minerals, antioxidants, detoxification markers, gut imbalances and even heavy metal exposure.

The results from the NutrEval test are easy to read and come with useful tailored “recommended dosages” of vitamins, minerals, amino acids, probiotics and digestive enzymes based on the results of the test itself:

The suggested supplement schedule above is from my own NutrEval test from a few years back.

If you wish to find who offers this test, search for an “integrative medicine” or “functional medicine” practitioner near you.

A great resource is the list of practitioners offered by The Institute For Functional Medicine which you can access by clicking here. 

In previous articles, I’ve taken some deep dives into the biochemistry of our cells, discussing energy production in the mitochondria, methylation and more. Understanding these fundamental pathways allows me to use clinical data, including nutrient testing, to help explain an individual’s symptoms and support them in the path to health.

Micronutrient testing was helpful in my own healing journey in order to personalize the supplements I needed to take to correct the deficiencies – including B vitamins, certain minerals and mitochondrial support – that ultimately allowed my own healing and return of energy.

We all have different nutrient needs. Because of our genetics, personal biochemistry, diet, lifestyle and other factors, some of us might need more of certain nutrients than others.

Also, just because we eat a “perfect” diet doesn’t necessarily mean we absorb the nutrients we consume. This is why we need a comprehensive nutrient (and toxin) test like the Genova NutrEval.

What is the process for determining the nutrients that your unique body needs to heal from disease and achieve optimal health? This is what I’m going to dive into today. 

In this article, you will learn more about:

• Micronutrients, antioxidants and other nutrients to keep on your radar
• The links between nutrient deficiencies and disease
• Why testing for nutrients is important and who this testing is for
• Why nutrient deficiencies are so common
• How to test for nutrient status, including specifics of the NutraEval test
• An interesting case study using this test

Let’s get started!

What Are Micronutrients? And Other Nutrients Of Concern

Contrasted to the macronutrients – protein, carbohydrates and fat – that are required in large amounts in the diet for energy metabolism, building structure and other functions in the body, micronutrients are needed in much smaller amounts. Micronutrients most often are the catalysts of metabolism, the gears and the grease that help convert what we eat to usable energy such as ATP.

Micronutrients include vitamins and minerals, typically in milligram (mg) or microgram (mcg) amounts in the diet, and are indispensable for optimal function of all body system. They are important for growth, development, metabolism and health across the lifespan, and because of this, vitamins and minerals are considered “essential.” (Source 1) Without these essential nutrients, deficiency symptoms can occur.

For example, a vitamin D deficiency, might mean low immunity or decreased bone health and its most extreme form, rickets. Or, a vitamin C deficiency, might lead to signs of aging or decreased resilience to stress, or in the extreme case, scurvy.

In addition to the vitamins (vitamins A, C, D, E, K and all of the B vitamins) and minerals (including calcium, iron, magnesium, chromium, selenium, zinc and more), I also consider antioxidants to be extremely important. Antioxidants work to neutralize free radicals and protect cells – and mitochondria – from damage caused by metabolism and toxins. Antioxidants include some of these important vitamins and minerals, but also compounds such as Coenzyme Q10, glutathione, alpha lipoic acid as well as many phytonutrients, or plant compounds, such as beta carotene and curcumin.

For a more in-depth discussion of the roles that vitamins, minerals and antioxidants play in health, see my article Advantages of Taking Liposomal Multivitamins with Minerals.

When it comes to nutrition, a well-rounded approach is key and when we get to testing, I’ll also be covering a few details about amino acids – the building blocks of protein and essential fats, especially the omega-3 fats that are incredibly anti-inflammatory.

The Health Impact Of Micronutrient Deficiencies

Micronutrient and essential nutrient deficiencies are widespread. While we might only think of malnutrition affecting developing areas of the globe where food is scarce, nutrient deficiencies are a global problem. In fact, deficiencies are quite common where food is abundant and are associated with obesity. (Source 2)

Our modern food supply composed of highly processed and highly palatable food is calorie-rich, but nutrient poor. The body receives adequate macronutrients, but micronutrient deficiencies are increasingly common. One study pointed out that those with obesity are likely to be deficient in most nutrients, especially the fat soluble vitamins (vitamins A, D, E and K), vitamin C, folate and vitamin B12. (Source 2)

The 2015-2020 dietary guidelines identify the following micronutrients as under consumed and “nutrients of public health concern”: vitamin A, vitamin D, vitamin E, vitamin C, choline, calcium, magnesium, iron (for certain groups including children and pregnant women), potassium and fiber. (Source 1)

Vitamin D deficiency affects 1 billion people globally and is described as a “pandemic,” associated with widespread chronic disease. (Source 3) 50% of U.S. adults don’t get enough magnesium in their diet, a mineral needed for over 300 biochemical reactions in the body. Magnesium deficiency correlates with type 2 diabetes, Alzheimer’s disease, heart disease, high blood pressure, migraines, ADHD and more. (Source 4).

When diving into the research, it is clear that micronutrient deficiencies contribute to symptoms and disease. Here are a sprinkling of health conditions that have been associated with micronutrient and essential nutrient deficiencies, but really these nutrients play a role in every cell, tissue and system in the body.

Nutrient deficiencies are related to:

• Metabolic syndrome, insulin resistance and diabetes (Source 5, 6)
• Depression and anxiety (Source 7, 8)
• Heart disease (Source 9, 10)
• Inflammation (Source 11)
• Fatigue (Source 12, 13)
• Overweight and obesity (Source 2, 14)
• Celiac disease (Source 15)
• Thyroid diseases (Source 16)
• Infertility (Source 17)
• Headaches and migraines (Source 18, 19)

I could go on. The truth is that nutrition and micronutrients are important for every biochemical process that happens in the body and when deficiencies are present, the system isn’t able to function optimally allowing symptoms and disease develop.

Why Consider a Vitamin And Mineral Deficiency Test? Who Is A Micronutrient Blood Test For?

A comprehensive micronutrient test is an important tool in the functional medicine toolkit. It supports a personalized approach to prevention, health and healing. It helps us to gather clues to point towards a root cause of symptoms or disease. It also helps us to optimize an individual diet and supplement approach because it points to your unique biochemical individuality. Micronutrient testing allows us to understand more about hormones, immunity, detoxification, metabolism, genetic expression and more!

So, really, a micronutrient test and looking at specific nutrient deficiencies is important for everyone! This includes those with undernutrition or malnutrition, including the elderly, who are more at risk for nutrient deficiencies as well as are those who have excess weight or chronic disease. Micronutrient testing is suggested for those with headaches, fertility concerns, autoimmune disease and the other symptoms and disease states discussed above.

Even if your diet is dialed in, there might be other reasons that you aren’t getting enough of what your body needs. Let me explain.

Reasons Behind Low Micronutrient And Nutrition Status

Before we dive into the details of testing for nutrients, let’s cover the why behind low nutrient status. The reasons fall into 3 categories:

1. Low intake. This is what typically comes to mind when we think of nutrient deficiencies; we don’t have enough nutrition – vitamins, minerals, antioxidants, amino acids, essential fats - in the body, simply because we aren’t eating enough.

Low intake of food explains malnutrition, but low intake of certain nutrients is also possible when eating enough overall calories. A standard American diet (SAD diet) that we discussed being high in processed food and macronutrients, may be low in micronutrients and other essential nutrients from a lack of whole foods including plant foods. Long-term specialized or therapeutic diets may also inadvertently cause nutrient deficiencies. These include vegan and vegetarian diets, the keto diet and others.

In addition, with widespread modern agriculture practices, many foods are less nutrient- dense than they once were. Less nutrition in the soil equates to less nutrition in the food and then less in the body. This helps to explain nutrition gaps in even those with the healthiest, most complete diets. Instead of a soil nutrient tester, we can test you!

2. Issues with digestion and absorption. For those eating a well-balanced whole foods diet that supplies optimal nutrients, issues with digestion or absorption may lead to nutrient deficiencies. Problems such as low stomach acid, low enzyme production, GI infections and microbiome imbalances affect the digestion and absorption of the food you eat. If this is the case for you, the next step would be comprehensive stool testing and treating the root cause of the digestion/absorption issues.

3. Increased needs. There are many instances where we may have increased needs for a specific nutrient or group of nutrients. These include:
   
   
4. Times of growth. Infants, children, pregnant and nursing women all have increased needs for particular nutrients that are not always met through the diet alone.
   
   
5. Genetics. You may have certain genetic SNPs (single nucleotide polymorphisms) that correlate with an increased need for a specific nutrient. For example, many with the MTHFR SNP, may need additional B vitamins, especially folate and vitamin B12. To learn more about methylation, read my recent article on the topic.
   
   
6. Toxic burden. When recovering from toxin exposures, nutrients, such as glutathione, become depleted and the body may have increased needs in order to promote detoxification.
   
   
7. Injury or illness. When recovering from physical trauma, the body has increased nutrient needs for wound healing. (Source 20)
   
   
8. Athletes. High level athletes also have increased nutrition needs, not just increased energy (calorie) needs, but micronutrients, amino acids and antioxidants are also important. (Source 21, 22)

How To Test For Vitamin Deficiency

When it comes to functional medicine testing for nutrients, there are several labs that offer comprehensive testing. I’m most familiar with the Spectracell Micronutrient Test and NutraEval from Genova Diagnostics.                                                                                     

As a doctor, instead of ordering separately a vitamin C test, a vitamin E test, a vitamin D test and so on, it makes sense to order a comprehensive panel that looks at all of the vitamins, minerals and antioxidants of interest. All of the nutrients work together and this type of functional testing tells an important story and provides a solid branching point for additional exploration. Additionally, it can be hard to get an accurate representation of nutrient status solely based on blood levels, as we want to look inside of the cell to truly understand if someone has enough of that nutrient for optimal function of the cell.

The Genova NutrEval FMV test: my favorite tool for evaluating nutrients and potential toxins

Let’s walk through an example of the NutraEval test.

This test collects both blood and urine to evaluate over 125 biomarkers in the body that assess the body’s functional need for these nutrients. This vitamin test requires collecting the “first morning void” urine sample and then having a fasting blood draw that same morning. The vitamin and mineral test kit is then mailed to the lab and results are sent to the ordering clinician. The vitamin deficiency test cost will vary based on whether you use insurance, pay the lab directly or have a financial arrangement with your provider. It typically runs a few hundred dollars, which is well worth the price, in my opinion, once you see how much data the test provides.

The NutraEval test provides results for:

• Metabolic analysis markers, also known as urine organic acids. These are products of metabolism (metabolites) that provide insight into:
  • Digestive and microbiome health (ex: malabsorption, SIBO) 
  • Cellular energy production and mitochondrial health
  • Neurotransmitter levels
  • Vitamins that are cofactors to certain enzymes, including B vitamins
  • Toxins and detoxification capacity
• Amino acids – the building blocks of protein
  • Essential amino acids (the ones we need from the diet)
  • Nonessential amino acids (the ones that the body makes from the others)
  • Intermediate metabolites of amino acid metabolism that inform us about B vitamin status, the nitrogen cycle and methylation.
• Fatty acids – the building blocks of fats
  • Essential omega 3 and omega 6 fats – that we need to get from the diet
  • Saturated, monounsaturated and polyunsaturated fats
  • Delta-6-desaturase – this is an enzyme required to turn shorter chain fats into longer ones, such as EPA and DHA
  • The omega 3 to 6 ratio and other markers linked to cardiovascular risk
• Oxidative stress markers
  • Glutathione – the body’s master antioxidant
  • Coenzyme Q10
  • Lipid peroxidases
• Vitamin D blood test – measures 25-hydroxyvitamin D3
• Minerals
  • Copper, magnesium, manganese, potassium, selenium, zinc
• Toxins:
  lead, mercury, arsenic, cadmium, tin

Nutra Eval Case Study

Here are some parts of the NutraEval results from a patient of mine. She’s a woman in her late 30’s with a history of hormonal migraines. Besides the migraines that occur 3-4 times per month, she complains of fatigue as a main symptom. At the time of testing, she had recently discovered toxic mold in her main bathroom at home and was having it renovated.

Let me walk you through some of the most interesting results in this case. In the results overview below, the antioxidants, vitamins and minerals in green are in the optimal range, the yellow is borderline and the red are nutrients she needs more of.

A first glance interpretation goes like this: everything on the left in the green column are good or optimalnutrient levels. The yellow and red columns are where nutrient deficiencies are shown (red being more severe than yellow).

As you can easily see, most of the B vitamins are in the yellow and red ranges and antioxidant status is not currently optimal. All of these nutrients play a main role in energy production, i.e. mitochondrial health. That is where the body turns macronutrients into energy for the cell. In my article discussing multivitamins, I walk you through the Citric Acid Cycle (also known as the Krebs cycle), which is a main step in this process. 

In this diagram from my patient’s NutraEval, we can see her individual levels for each of the intermediaries in this cycle.

I love this diagram because it is so visual and we can see the important nutrients needed for the gears to keep turning to make energy (ATP).

For this person, most of her Citric Acid Cycle intermediates (citric acid, isocitric acid, succinic acid, etc) are in the optimal range, despite the lower levels of nutrients we discussed from the previous picture.

Let’s take a quick look at some other key findings from my patient’s NutraEval.

Here you can see we measured some byproducts of yeast and bacteria that were eliminated in urine. Measuring high levels of yeast and bacterial byproducts in the urine indicates that there may be an overgrowth (or imbalance) of yeast and bacteria in the small intestine that her body absorbs into the circulation.

An obvious next step might include obtaining a detailed stool analysis or a breath test.

If confirmed, a condition called Small Intestinal Bacterial Overgrowth (SIBO) or it’s “cousin” Small Intestinal Fungal Overgrowth (SIFO) can begin to explain the low levels of B-Vitamins as both of these conditions are associated with poor absorption of nutrients, i.e. “malabsorption.”  You can begin to understand how the NutrEval test can be useful as a clinical decision making branching point in further investigating an abnormal result.

This diagram shows some environmental toxins  at a glance. MTBE comes from gasoline and petroleum products for example. These are some clues that the patient is experiencing a toxic burden and may need additional help with detoxification. If these toxins are present perhaps other metabolic “blockers” such as heavy metals are also accumulating and need to be measured.

Let’s take a look at balance of fats. Although many of her nutrients were in the optimal ranges, including omega 3 fats, you’ll see that her omega 6 fats were in general a little low, causing a lower-than-optimal omega 6 to omega 3 ratio. Most people have a high ratio, with too much Omega 6’s in their diet, which presents a high cardiovascular risk. Omega-3’s are considered the  “healthy” fat, but really the ratio and the balance between Omega 3 and 6 is what is important and needs to be maintained. She had high levels of the delta-6 desaturase enzyme that helps the body to convert dietary omega-6s into the important longer-chain fats, but this conversion wasn’t happening very well.

Here are some other important marker’s covered in the NutraEval test that are important to evaluate for patients. 

Glutathione:

I always look at glutathione levels since it is the master antioxidant and important for detoxification. As you can see, my patient’s level was outside of the optimal, green range, indicating depleted glutathione potentially from toxin exposure.

Minerals and Heavy Metals:

Another key aspect of the results from a Genova NutrEval is the balance of the key beneficial minerals like Magnesium and Zinc and the dangerous “Heavy Metals” like Mercury, Lead, Cadmium and Arsenic.

This diagram shows minerals as measured in Red Blood Cells (RBCs) from a 45 year old man who was having fatigue, blurry vison and some muscle weakness.

You can see that the essential minerals are balanced, but there are  “heavy metal” levels of mercury, lead and cadmium which are very concerning as they wreak havoc blocking energy production in mitochondria, causing neurological impairment and increasing oxidative stress on cells.

Certainly this patient will need to consider additional measures to gently remove these heavy metals with the help of natural chelators, bile binders and sauna sessions to increases sweating. Stool (bile), urine and sweat are the main elimination pathways for heavy metals.

It is also imperative to add liposomal glutathione to a heavy metal detoxification regimen, as glutathione binds and neutralizes heavy metals and escorts these dangerous chemicals out of our bodies in bile and urine by increasing their water solubility. This process called “conjugation” is a key protective role glutathione plays in “Phase 2” of detoxification.

All in all, in these case studies I saw many connections between nutrient status and symptoms.

In the case of our example female patient, we were able to put in place some important nutritional support to help her achieve optimal levels of these nutrients for her unique biochemistry. Our plan included:

• Optimizing B vitamins by adding in a multivitamin with B Complex to support energy and reduce episodic migraines. Interestingly, riboflavin deficiency correlates with migraines (Source 18) and the B vitamins also improve methylation status, which can further support hormone balance that are the root causes of migraines.
• Increasing mitochondrial support in the form of antioxidants. Here we used Acetyl-l-carnitine and alpha lipoic acid (add link to product?) and phosphatidylcholine.
• Additional detoxification support given mold exposure. A key supplement here is glutathione.
• Increased fish oil, using an algae based product, in order to help balance her omega 3 and 6 fats. Evening primrose oil was a helpful supplement here as well as it provided an omega 6 fat that her body was having a hard time making.
• Added in a probiotic to address the gut dysbiosis.
• Added more colorful, fiber-rich plant foods to the diet to support the microbiome, detoxification and hormone balance.
• Next steps: testing for mold toxins in the body and comprehensive stool analysis.

Remember that these recommendations were unique to her case, and aren’t meant to substitute for your own vitamin levels test and working with your provider for a personalized plan. Here are the practitioners that I recommend trained in interpreting the type of functional testing discussed here and integrating into a patient-centered approach.

Summary Of The Key Points You Learned Today:

• As far as micronutrients and essential nutrients, we are interested in vitamins, minerals, antioxidants, amino acids and essential fats.
• Deficiencies in these nutrients correlate with many symptoms and chronic disease including: obesity, diabetes, fatigue, heart disease, autoimmune disease, infertility and more.
• Micronutrient testing is an important tool that allows us to dig deeper and connect the dots when forming a functional medicine treatment plan.
• Pretty much everyone is a good candidate for this type of testing.
• Nutrients deficiencies occur because of low intake, digestion and absorption issues or increased needs.
• A comprehensive nutrient test is as simple as a single urine and blood collection and provides a large amount of data.
• A liposomal multivitamin may help to fill in vitamin and mineral gaps, but nutrient testing is indispensable in personalizing a supplement and lifestyle protocol.

Are you curious about how nutrient levels and your individual nutrient needs play a role in your health challenges? My hope is that this article is helpful for seeing just how helpful testing can be, in so many cases. Nutrition is foundational to health and when even one level is off, it can have far reaching effects in the body. Restoring nutrient levels and nutrient balance is key to living your best, most abundant life!

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