Examining the Value of Blood Testing to Personalized Vitamins
It is commonly assumed that blood testing is required to personalize a daily vitamin, but upon closer examination, it is often not the case that someone would need to subject themselves to painful blood draws to properly compose and dose their vitamin. In fact, many insurers have stopped paying for vitamin levels in standard blood testing, and do not suggest that this approach is valid as a population-based measure. What is the promise of blood testing as compared to the current reality of blood testing when it comes to vitamins?
There are frequent reports of people going to various naturopathic or functional medicine practitioners, who in turn, order extensive (and expensive!) panels of endless levels of various vitamins, hormones and other items. Typically, the results of these multitudes of levels then dictates the prescribing of many expensive (and often unproven supplements). But, as the saying goes, buyer beware! If something seems over the top it probably is. The medical data suggests that too much testing is overkill and a few key levels have their role and can be useful to health care. Blood testing for many vitamins is often not accurate or useful. For example, magnesium levels are often inaccurate and not reflective of true need.
So, why do some personalized vitamin companies claim that blood testing is integral to their process? These companies are often seeking a hook to get people to try their product, and there is the pervasive myth that blood matters to vitamin recommendations. When independent journalists have tested these services, they report that the blood test results do not match their own doctor’s office generated results, and then there is the confusion stemming from which test to believe. Plus, blood is a snapshot in time, it does not indicate where vitamin levels might be trending based on health status and lifestyle choices. There is a significant cost premium to pay for blood testing, and in most cases, it will not provide commensurate value when compared to less invasive methods like a well-structured survey diagnostic.
The Truth about Blood
In blood testing, the most common vitamin levels that are checked include vitamin D, vitamin B12 and iron. And yes, it’s true that many people are deficient in these nutrients! However, checking levels is often not necessary or that helpful in telling providers about these deficiencies. It turns out that it’s usually fairly easy to predict who is deficient in which vitamin based on various factors including age, diet, lifestyle and health issues.
A standard blood panel tells you about Vitamin D, and doctors often joke they can predict your vitamin D levels form a mile away if they know that you live in a cold climate with limited sun exposure like Chicago or Minneapolis. As opposed to a blood test, it is critical to ask the right questions so you can identify factors that determine how much Vitamin D you need to be taking on a daily basis to help to correct deficiencies and maintain an optimal level. It turns out that we do not all have the same needs. In addition to where you live, things like race (skin pigment affects vitamin D absorption) diet and other factors help determine these needs. During the pandemic, there have bene many social media influencers pushing ultra-high doses of Vitamin D. These can be dangerous to your health and can impact organ functioning in some cases.
To further illustrate this point, there is often vitamin B12 deficiency in people who keep a vegetarian or vegan diet. In addition, certain people as they get older can benefit from B12. The challenge with B12 blood levels, is they are not always accurate and can often be normal despite deficiency. In certain cases, the low end of normal is actually low. In general, taking a B12 oral supplement in those who we suspect deficiency or need based on their diet, lifestyle and health concerns, is the way to go. However, there are rare cases of people with extreme needs, typically those who have had portions of their GI tract removed or bypassed (such as after gastric bypass surgery), had major intestinal illnesses such as Crohn’s disease or with intestinal absorption issues such as Celiac disease. These are examples of people, who at times, need to take B12 either sublingually or via injection if oral supplements do not suffice.
Finally, iron levels, can be of use but these specialized blood tests are done rarely. More commonly, doctors run blood counts, which can show if someone is anemic. Many physicians and health practitioners falsely assume that a normal hemoglobin on a CBC means that you do not need to take iron. It turns out that many of the patients that doctors evaluate who are not in anemic, but they do have low total body iron stores as seen when measuring a ferritin level. Many women have low ferritin levels likely because their iron supplies have been depleted from years of having periods, pregnancies and nursing babies. Furthermore, they tend not to eat red meat, which is the best dietary source of iron, in the quantities needed to build back up iron stores. Similarly, men too often have low ferritin levels, which is perhaps due to less red meat consumption or iron absorption. Many people do not recognize the symptoms they are having from low iron (including low energy, thinning hair or hair loss, fatigue, brittle nails). Repleting iron depends less on the actual iron levels and more on finding a tolerable form of iron to consume each day. Many people get discomforting side effects from certain oral iron preparations, thus finding the right form of iron as well as pairing it with the other nutrients to help absorption is key.
Another misconception about blood testing revolves around calcium. Consumers often want to know how much calcium they should be taking based on blood testing that includes a serum calcium. However, calcium levels in the blood do not reflect if you are getting adequate calcium intake. Your body should maintain a normal serum calcium no matter your diet. It will however, leech calcium from your bones if you are not eating enough calcium. This is why getting enough calcium in your diet is essential (and a supplement when necessary) but blood testing is of no value in determining this course.
Long-term Prospects of Blood Testing for Personalized Vitamins
The at-home testing market is rapidly evolving, and there may come a point when blood tests make sense for vitamin recommendations from a cost and utility perspective. There are many “ifs” to get to this future world:
- If the out-of-pocket cost of blood vitamin levels drops to tens of dollars instead of hundreds or thousands of dollars
- If the accuracy of at-home tests improves
- If blood levels prove most instructive then survey-based questions in finding deficiencies
- If the administration of these at-home tests is safe and properly done
- If the pain threshold of these tests does not deter consumers from advancing into personalization
The promise of population-based blood testing for vitamin deficiencies cannot be totally dismissed, but today it should be regarded with an appropriate degree of skepticism.
There are many companies that are offering a well-structured survey tool with clinically validated questions to get at vitamin needs. While the consumer may be surprised that these surveys work without blood, they actually do provide valuable feedback around vitamin needs. Many companies will use survey results to suggest standard supplements compiled into a daily pill pack. The consumer should realize that pill packs may entail taking 10+ daily pills and spending more than $100 per month. For many consumers, this format is untenable and unsustainable. Other companies will customize a daily all-in-one multivitamin with curated nutrients and optimized dosing. This format is usually 2-4x less expensive than pill packs and provides a more sustainable path to long-term usage.
Assuming the key to personalized vitamin recommendations is asking the right questions, which personalized vitamin brand can be trusted to put together a high-quality survey. It is important to look at the founders and team behind the brand. Are there physicians with strong credentials involved with the company? Do you trust the research and expertise in featured books or blogs? Do the customer testimonials attest to the quality of the products? Has the company been around for a good period of time? Are there trust symbols like Good Manufacturing Practices (cGMP) or made in the USA? Does the pill load and cost seem reasonable? There are many companies jumping into personalization, so it is critical that you complete your homework and look into the company’s background. A sensible approach to personalization does not necessarily involve expensive and painful blood tests, but rather an ongoing and trusted exchange of health and lifestyle data to ensure that your vitamin matches your current needs.