Men's Lab Panels 101 (Part 2)

By Dan Covert

(If you missed Part 1, be sure to check it out)

Essential Vitamins and Minerals

While levels of essential and very commonly-deficient vitamins and minerals such as vitamin D, certain B vitamins, and iron seem like a no-brainer to check, I see several (if not all) of these tests left out from routine lab panels all the time.

Here are the ones you definitely don’t want to skip:

Vitamin D

At this point, I’m not sure why vitamin D isn’t a routine draw the way a CBC or CMP is, as some estimates suggest that as many as 2 out of 3 Americans have "insufficient" (in other words, deficient) levels of this essential vitamin, and I'd venture to say that the number of people with truly suboptimal levels is actually even higher.

Vitamin D is crucial for calcium absorption and bone health, immune function and inflammation control, cellular growth, neuromuscular function, glucose metabolism, and even mood and mental health. Given this in conjunction with the utterly staggering rates of deficiency, just about everyone should be supplementing.

Lab reference ranges usually consider anything above 30 ng/mL "normal", while 60-80 ng/mL is optimal.

Vitamin B12

Vitamin B12, also known as cobalamin, is another common deficiency, with around 2-3% of adults in the U.S. meeting the criteria for “true” deficiency, while up to 20% have suboptimal levels, which can and often does cause deficiency symptoms.

B12 is involved in a number of processes, including supporting red blood cells, DNA synthesis, nerve cells, memory and overall brain function, mood regulation, and energy production. Deficiency symptoms often show up as fatigue, cognitive issues, anxiety, or nerve problems.

An optimal level of B12 is at least 500 pg/mL, ideally shooting for the upper end of the lab reference range, or around 1,000 pg/mL.

Folate (Vitamin B9)

Similar to B12, folate is only considered “deficient” in a small percenage of the U.S. population, yet around 20% of people meet the criteria for suboptimal levels. Deficient or low-normal levels can also cause similar symptoms as low B12 can, as folate is involved in many similar processes.

A serum level of at least 7 ng/mL is usually considered to be the minimum for optimal health, with many functional medicine practitioners preferring to see levels into the teens.

B6

Vitamin B6, or pyridoxine, is rarely “truly” deficient, but once again, a suboptimal level is common, occurring in around 10% of the population. It can show up with symptoms such as neuropathy, rashes, depression, confusion, or anemia.

The optimal level is usually cited to be at least 12 ng/mL.

When it comes to B vitamins, it is also important to note that an estimated 40-50% of the population has one or more of several possible mutations in a gene known as “MTHFR”, which essentially means that these individuals may struggle to absorb certain formulations of several B vitamins, including B12, folate, and B6. As a result, these individuals often require methylated versions of B vitamins in order to properly utilize them and achieve adequate levels.

In my experience, many (or even most) people with deficiencies in these vitamins have an MTHFR mutation, so I typically recommend clients take a methylated B-complex or multi-vitamin when supplementing to be safe, unless they wish to have testing done to determine for certain if they have a gene mutation, or they have a known sensitivity to methylated vitamins (which can sometimes occur in the form of anxiety or overactivation).

Ferritin (Iron)

Some estimates suggest that up to one-third of adults meet the criteria for ferritin deficiency. For all intents and purposes, we call this an iron deficiency, since ferritin is the protein that stores iron and is a more functional measurement of stores in the body, given that serum iron levels tend to fluctuate often and easily. Symptoms of ferritin/iron deficiency often show up as fatigue, weakness, pale skin (as well as inner eyelids and tongue), shortness of breath, and cold hands/feet.

Getting enough iron in the diet typically requires a solid intake of red meat and seafood. Animal sources, specifically, contain heme iron, which is a highly bioavailable form not found in plant foods. Even with adequate dietary intake, some people struggle to absorb iron in the gut due to inflammatory conditions, such as celiac disease.

If ferritin is deficient or suboptimal (usually <50 ng/mL), further testing of serum iron level, TIBC (total iron-binding capacity), and TSAT (transferritin saturation) becomes useful to see if supplementation is warranted. Iron must be dosed precisely and routinely monitored, as having too much iron can cause toxicity long-term.

Not Routine, But Still Relevant

Magnesium

While magnesium deficiency is thought to occur in around half of all Americans, blood levels only measure <1% of total magnesium in the body. For this reason, testing typically isn’t useful, so it is often recommended that everyone supplements magnesium, as most people could use more of it. Magnesium is responsible for hundreds of processes in the body, and adequate intake from supplementation (especially magnesium glycinate) can noticeably help optimize sleep and lead to improvements in anxiety and mood in some people.

Vitamin C

While vitamin C deficiency is considered rare in developed countries and only affects around 7% of the U.S. population, around 40% of Americans have inadequate levels. Vitamin C is a potent antioxidant that protects cells from damage, boosts immune function, and aids in collagen synthesis for skin, bone, and vascular health. It also enhances iron absorption, so we can see how these two deficiencies can occur together.

Since levels are commonly suboptimal, symptoms can be hard to pinpoint and non-specific (fatigue, easy bruising, joint pain, and poor wound healing), and since it’s virtually impossible to get too much of it, vitamin C is another vitamin that most people should be supplementing.

If you’re interested in testing your level, note that while clinical deficiency is listed as less than 0.2 mg/dL, anything less than 0.6 mg/dL is considered functionally deficient.

Methylmalonic Acid (MMA) & Homocysteine

Methylmalonic acid and homocysteine are metabolic byproducts of B12 (MMA primarily, but also homocysteine), folate (homocysteine), and B6 (homocysteine) that are sometimes used to diagnose deficiencies with increased accuracy. As more sensitive markers of these B vitamins, elevated levels can paint a more precise picture of functional deficiency, particularly in cases of borderline or early deficiency. If your B12, folate, or B6 levels are low-normal or deficiency symptoms are suspected, these tests can be useful follow-ups to determine a more accurate read on things.

https://www.youtube.com/watch?v=E8bVDpvMHL8

Next up: Part 3, where we’ll dive into all things related to hormones…