I write perhaps three big essays per year. Here's what it takes for me to bother. First, the story must be important and must not've been covered by others. Second, it must've involved me personally, and hence, I've got a unique personal story to tell. (One of my PhD advisors asked me, "what is the unique contribution of your work that others must know?" That's my mandate here.) The following story checks all these boxes.
One obvious answer to the question "do vitamin pills or supplements actually do anything" is this. Did the supplements correct your problem or make you feel better? Easy, huh? Forget it! As a medical researcher I'm going to dismiss that immediately (it gets a qualified maybe.) If you got better or worse, it may've had nothing to do with your vitamin pills or other supplements. I discussed the evaluation of supplements here: Does Drug X Actually Work? (The default answer is "no!" Making health claims for supplements is typically (but not invariably) the province of charlatans.)
(One of Tom Jech's delightful cartoons on fallacious thought.)
But you can determine whether your vitamin pill or supplement actually changed your blood or body chemistry ... by measuring blood or tissue levels. Here I report on three labs that you (and your doctor) may never've heard of that measure your levels of blood and cell micronutrients.
First, what are micronutrients? Briefly, they're the chemical elements, vitamins, and other molecules present in microscopic amounts in food. You know the macronutrients: carbohydrates, fats, and proteins. They're present in kilogram quantities in your body. In contrast, many of the micronutrients are present in your body in only microgram quantities, although they're essential for life.
If you're like me, you probably assume that almost everybody who is eating greater than 2000 calories a day gets plenty of micronutrients. Well, maybe and maybe not. (There's only one way you can know for sure and that's by measuring micronutrient levels in your blood and in your cells.)
Here are the companies whose tests I will cover: Request A Test (that's a front-end for Labcorp and Quest Diagnostics,) SpectraCell, and Vibrant America.
I've not used Request A Test, but I'll start with it because its tests are available to the general public without your even needing to see a doctor. By the way, this essay is about three for-profit lab corporations. (They'd love to do a wallet biopsy. So, only use them if you need to.) I have no connection, financial or otherwise, with any of the three. (But I needed their services, and you might, too — hence, this essay.)
Let's start with Request A Test . As you see, Request A Test offers hundreds of tests of almost (but not quite) everything. You simply go to one of the blood drawing stations operated by either Labcorp or Quest Diagnostics and pay with your credit card. No insurance and no doctors are involved. It's just you and them. (Both Labcorp and Quest Diagnostics happen to have dozens of labs close to me. So, hopefully, it's convenient for you, too.)
Now, obviously if you can get the tests you're interested in through your own doctor and insurance, then do that. It'll be cheaper. But, Request A Test is a backup, if you don't have a willing doctor or insurance.
Now — on to micronutrients and to my personal story. Most of my professional writing is focused on neuroscience and AI. Principally, I only cover biomedicine (even though I was a full-time emergency physician for twenty years) if it's a story that involved me personally (or unless it's an under-reported blockbuster, eg see my write-ups on French artificial heart maker Carmat and on French artificial retina maker Pixium, developed by Stanford's Prof. Daniel Palanker.)
Here's why I'm writing about micronutrients. In brief, over perhaps a two year period my health went totally to hell. If you've looked at my website, you know I'm a lifetime athlete and devotee to health. Also note that I only began to focus on nutrition about a decade ago with my essay on optimal nutrition.
As you'll see from that essay my emphasis was and has always been on avoiding atherosclerosis. (I've got it, and if you're a man my age, so do you. If you doubt it, get a coronary calcium scan or a carotid ultrasound.)
The nutrition gurus I've followed are largely physicians who emphasize vegan diets. You may know their names: Dean Ornish, Caldwell Esselstyn, Joel Fuhrman, Sanjay Gupta, John McDougall, Michael Greger, Colin Campbell, et al. (an esteemed bunch; and in what follows I don't mean to detract from their work or their vegan philosophy.)
Unfortunately, for me my particular brush with veganism was a catastrophe. I won't keep you in suspense. My weight dropped from 152 pounds down to 135 pounds (I'm 5 foot 9 inches; at 135 lbs, that's a bmi of 20.) I'm ok with that bmi. But not with the weakness, dizziness and burning in my feet that also ensued.
Note: I'm loathe to point the finger solely at my vegan diet. (My friends know I'm a terrible cook and spend almost no time in the kitchen. I was eating a lot of rice cakes and lettuce/tomato salads.) Furthermore, here's one (among many other) complicating factors.
I had been a frequent blood donor for years (4-5 times per year.) And had mainly monitored only my hemoglobin levels. (How can anybody be that stupid?) My iron levels had gotten down to dangerously low levels.
So, my iron levels (and ferritin and transferrin) were the first focus of my attention. I repleted my iron stores over about year, and that helped restore my strength, but did not help my distal neuropathy or dizziness.
As you might expect, I have excellent medical care but despite batteries of tests, nothing was turning up.(My vitamin b6, b12, and d levels were normal (I supplemented those.)) But, in the course of this long workup, one test result surprised me: my vitamin b1 (thiamine) level was way below normal.
I started taking thiamine 100 mg three time a day (in September, 2018 and with good results.) But, I wondered ... if my blood thiamine was so low, how about all the other unmeasured dozens of vitamins and intermediary metabolites. The quest for this answer (and serendipity that followed) is what motivated this essay.
Talking with nutritionists, I soon discovered the next lab company: SpectraCell. SpectraCell has been in business for twenty six years and grew out of patented research on lymphocyte growth testing. Take a look at their micronutrients test. It's a panel of about thirty micronutrients that they test in your blood and in your white blood cells (specifically, your lymphocytes.) Many of the tests they do are done by almost no one else. (Every lab can test your blood calcium and magnesium, for example, or your blood vitamin b6 or b12; but how about your blood selenium or coenzyme Q10... and how about the levels of dozens of metabolites in your cells. Not so easy, especially if they're only in picogram amounts.)
But, the first thing to know is what does it cost? Answer: $400 - unless covered by insurance. I called their sales rep and she, obligingly, gave me a discount on my first micronutrient panel. (I'm not one to spend 400 bucks without a ton of due diligence. I would need answers to questions like these. Are the tests accurate and reproducible? Have they been corroborated by independent labs using other methods? Are they clinically meaningful? That is, do low values reflect genuine deficiencies?)
Unlike Request A Test, you do need a doctor to order the panel for you. You then get your blood drawn at an affiliated lab. Then your blood is sent to Houston for analysis, which takes 2-3 weeks. Why so long? It's a laborious process that involves adding a succession of nutrients to your own living blood lymphocytes to quantitatively determine what they're lacking. SpectraCell's Micronutrient Panel is shown below.
My lymphocytes were lacking a lot! I was low in vitamin d, vitamin A, coQ10, and copper (all despite supplementation) and borderline in a dozen other intermediary metabolities. I started gobbling supplements of everything I was low in, and my distal neuropathy and dizziness began to improve. (Post hoc ergo propter hoc ... your results may vary.)
(One nice benefit from SpectraCell is a free series of consultations with nutritionists discussing your results.)
But still for me the nagging question was... are the results real? That is, are the test results accurate, reproducible, and clinically meaningful?
After a lot of searching I found another lab company that offers a competitive panel of micronutrient tests: Vibrant America (a start up in San Carlos, California, just down the road from me.)
Vibrant America just opened its doors in 2015 (so, it's new and somewhat flakey; you'll see online bitching about disorganization from ex-employees; don't let that deter you.) Vibrant was founded by entrepreneur John J. Rajasekaran. I looked at his patents here; he (and Vibrant) is the real McCoy. The company is based on proprietary microarray assays of low concentration metabolites.
Their panel costs $300 — not bad for what you get. (But, was this just throwing away three hundred bucks.)
So, it was either get insurance or Medicare to pay for it (not possible in my case) or pay out of pocket. After a lot of mulling this over, I finally decided to just fork over the $300. I had to find out if my test results from SpectraCell (and from Quest Diagnostics through my insurer) were real.
It was essential for me to find out whether the many deficiences uncovered by SpectraCell were confirmed by an independent lab... and they were, largely. Again, I was low or borderline on many intermediary metabolites.
Vibrant America works just like SpectraCell. You first get an order from a doctor (not necessary in my case), then get your blood drawn and sent to their lab. Again, the results take a couple of weeks as many of the tests are done on your own metabolizing lymphocytes.
Here is a sample report of test results from Vibrant America. Read this description of Vibrant's Micronutrients test and especially the section What Happens in the Lab. As you'll see, like SpectraCell's, their test procedures measure analytes not only in plasma but also in blood WBCs and also in RBCs (folate, iron, omega-3 and omega-6 fatty acids, and magnesium.)
You get a lot of data for the money. I only decided to spend the $300 when it was obvious that getting even a third of these tests from Quest Diagnostics (eg thru Request A Test) would cost more than $300.
Are the various labs accurate? I can't say definitely. Their analytical methods differ greatly, so it's hard to compare. For me, there was good qualitative concordance: if SpectraCell said I was low in one particular analyte, eg coenzyme Q10, I was also low on Vibrant America's tests. (I knew my coQ10 would be low; an expected effect from Lipitor, which I've taken for years.) How about reproducibility?
I haven't yet repeated these panels, but I've noticed a great lessening of my symptoms in the weeks since I started taking supplements. For your information, my main supplement is Naturelo Multivitamins (mainly (randomly) chosen because it's only 100% of daily vitamin RDAs, unlike many other brands.) I also started taking additional manganese, magnesium, copper, zinc, calcium (do NOT go overboard or you'll wind up with calcified arteries and kidney stones!!!) vitamin d, lutein, DHA/EPA omegas, and coenzyme Q 10.
Taking all these vitamins and supplements is a huge departure from my decades old mandate to get your micronutrients only from food. And, I'm looking to quit taking them when my individual levels normalize.
I persist in my belief that it's best to get your vitamins from food, but my experience here should show you that you need not guess about whether your vitamin intake from your food is adequate. You can measure your own blood and cell levels.
My main addition to my diet (there have been lots of modifications) has been broiled, wild salmon about four times per week. Yes, I measure my mercury level (it's 4 mcg/liter; top of normal is 10.) I've noticed that the vegan MDs whose work I admire spend a lot of time in the kitchen, juicing and preparing their vegetables. And many of them recommend supplements. Perhaps with more time and culinary skill, I'll be able to emulate them. For now, I'll continue eating salmon along with my kale... and measuring my micronutrients perhaps once per year.
I always welcome substantive comments on this and all my essays. Please send email to bob AT bobblum DOT com. With your permission I may include excerpts here (always modifiable by you.)
23 December 2021 - Reader W wrote:
Dear Dr. Blum,
I came across your article on Spectra Cell and Vibrant America a few weeks ago. I basically share the same philosophy in nutrition as you did then and now. Like you, my brief experiment with veganism was a total disaster. Long story short, I’ve since reached out to Vibrant America both by email and by phone, but have not heard back from then. You mentioned in your article that you were able to get a test by Vibrant America without a doctor’s order. Is it because you self-prescribed the order? Would you or do you have any referrals of doctors who are willing to write up an order for that. Many, many thanks and wish you and your family a wonderful Christmas!
I (RLB) respond — Hi Reader W:
I’m so sorry that Vibrant has been so hard to contact. That doesn’t speak well for their business, but perhaps their staff is working from home due to the pandemic (who knows?). I suggest continuing to call them. If you can’t reach them that would be discouraging, since you may need their help in arranging to get your blood drawn and in arranging your order. I did self-prescribe (and even with that it wasn’t trivial to get my blood drawn, etc.) I put up with this because their tests were relatively so cheap (especially their large panels (like micronutrients.) I don’t know why Vibrant seems to require a prescriber when Lab Corp and Quest seem to be able to market directly to consumers. Best of luck with your health, Dr. Bob
25 Dec 2021: Reader W continues:
Thank you, Dr Bob, for your prompt reply! And for raising attention to Vibrant America!
Have you considered writing a follow up article? In particular have you quit taking supplements and reverted back to your old mandate of getting micronutrients from food?
The order of my journey was a little different. I was first “poisoned” with mega doses of vitamins under the guidance of nutritionists to treat my fibromyalgia and hypothyroid. Then, in an attempt to cleanse my body of those synthetic substances, I turned to veganism. So it was one disaster after another. My iron levels were immensely depleted and, unfortunately, iron supplements made me constipated. I’m allergic to foods rich in iron such as spinach. So, at the end, Pork Blood, Spirulina and Black Strip Molasses were the foods that helped restore my iron levels back to normal. Fast forward to a few months ago, I restarted experimenting with supplements, a mixture of natural whole food supplements from ginseng, to nutritional yeast, to Krill oil, to name a few. As for synthetic supplements, I found Magnesium particularly intriguing, different forms of Mg appear to offer different benefits. Mixing it with Melantonin also seems to have some additional synergy effects that neither of them alone could achieve. Long story short, after trying the two extremes (mega-dosing and veganism), I now take a more moderate middle ground approach. While I also still firmly believe it’s best to obtain your micronutrients from food, I don’t reject supplementation (even synthetics) for short term use or until normal levels are restored. I believe tests offered by Vibrant America (the $300 micronutrient test which includes an RBC Magnesium level was what caught my attention) would be of tremendous help to monitor my progress or the lack thereof, especially since I no longer have insurance following a huge increase in my deductible.. It’s a total bummer that you have to order them thru a doctor, and probably only a very selective few have even heard of them.
25 Dec 2021: I (RLB) reply:
I'm so sorry to hear about your travails at the hands of the nutritionists.
My writing has slowed down during the pandemic since my main impetus derives from reporting on science progress at Stanford, which was closed from March, 2020 to October, 2021.
Please note: I'm not an expert in nutrition or metabolism, but with my science background I can at least discern real expertise (eg Rhonda Patrick’s) on YouTube, etc.
I'm hoping that one of the nutritionists at Vibrant can link you to one of their practitioners to order your tests with minimal added expense.
Iron: yes, repleting iron is a pain. The "one shot" method of doing that is with IV iron (if you have access to that.) I had to take oral iron for about 3 years to bring my levels back after they crashed following my poorly monitored community blood donations.
Thyroid testing: LabCorp and Quest have good panels, if that's still a problem.
Omega 3: Nordic Naturals for me (although some of my friends favor Krill oil.)
Sleep: for me, Magtein 2 hours before bed. I buy it on Amazon.
Diet: daily small fish (sardines, mackerel or herring) + steamed arugula, bok choy, etc.
My neuropathy has improved but is definitely not gone. I'm almost 75; I was sad to have to give away my downhill skis and put my backpacking gear into storage. (But hope springs eternal.)
I enjoyed this relevant article about Professor Mike Snyder's quantified self project that just appeared in Stanford Magazine in Dec, 2021.
28 Dec 2021: Reader W continues:
I took iron pills for months but they resulted in constipation and insomnia. I eventually quit them and resorted to natural foods only, in particular, pork blood curd (basically think of it as red tofu if the concept of blood grosses you out), in addition to spirulina and Black Strip Molasses. Somehow, my body craved for them, and I kept eating them for months until I didn’t feel like it anymore.
Also, my digestion was totally wrecked after the mega-supplement poisoning episode (despite trying all sorts of fancy probiotics at the same time under the guidance of nutritionists). The subsequent veganism just added more insult to injury. I was so depleted when I first came out of veganism, I drank 1 to 2 pints of raw milk (against all conventional wisdom and my food allergy test) for 3 straight days, and finally felt human again.
A bit more background information about my journey, it goes all the way back to 2007, when I sought out the help of nutritionists/ND/MDs to treat my chronic illnesses. Over the course of 1.5 years or so, I had a boatload of tests. Aside from periodic extensive blood works, I also had food allergy tests, heavy metal analysis, specialty tests by Doctor’s data on RBC Nutrient elements and Toxic Elements, as well as a couple of SpectraCells (which I had to pay for out of pocket.)
The food allergy tests was actually quite interesting. There were foods that I was consistently allergic to like spinach, eggs, cow’s milk and goat’s milk but foods such as mushroom, avocado, wheat didn’t always show up.
The heavy metal hair analysis by Trace Elements was also very interesting. My levels of Uranium were off the charts but still sub-clinical, so they didn’t do anything about it. The elevated levels of Calcium also jumped out at me, and according to their explanation that could be due to deficiency in phosphorus or magnesium, but I actually had moderately high levels of those elements in the same tissue test, so that means the only other explanation was I had an overall absorption or digestion problem or poor HCL production or low protein intake or errors in protein metabolism, which explains why I craved for easily digestible high protein foods such as spirulina or pig blood curd.
Omega 3: I really like Krill Oil, and my favorite brand is by Dr Mercola, zero fishy taste. I only like the Keto version in a blue bottle though, other Krill oils of his are super fishy, I threw them in the trash. The Kirkland brand is also a good old trusty one, I take it as well for additional Astaxanthin. Oh, almost forgot another fav of mine is Barlean’s organic cold pressed flax seed oil in the fridge section, very tasty, makes an excellent salad dressing.
Sardine, Mackerel, Salmon were on the list of foods to avoid, for me. I do eat fish sparingly since my spouse is Japanese and loves raw fish! And I like to add a bit of anchovies or Bonito Flakes (Japanese dried tuna flakes) in my salad dressing too. I have not tried Nordic, but it sounds good to me (most of the fish oils on the market are horrible).
Yes! Magtein is my latest Mg experiment.
I’m middle-aged and used to be very active. For years I blamed a skiing accident and poor recovery which eventually progressed to scoliosis and fibromyalgia. But a good part of it may have to do with my poor digestion, the alkalinity and excess calcium in my tissues. Your article really inspires me to run all these tests again.
Very interesting article by Prof Snyder, and what great wisdom “Nobody can track you better than you.”!!!
29 Dec 2021: I (RLB) respond:
OMG what a ride! One of the things I find frustrating is the public's focus on privacy (resulting in a massive lack of important health data.) The end result is we have no notion of how many people in the US have stories similar to yours — my guess is a lot. A policy that I regularly advocate is "Listen seniors; you want your social security checks? Give us your healthcare data (for epidemiology (while keeping it otherwise anonymous))"
Some random comments. Iron: I found out the hard way that hemoglobin is useless for following anemia. (ferritin and iron binding capacity indices are far more accurate.)
I believe SpectraCell's methodology may be outmoded relative to Vibrant's methods which are newer and possibly more accurate (although I'm bothered by the fact that Vibrant's "normal" group has only a few hundred people (ages unspecified.)) ... But, Vibrant is a helluva deal – I’ve gottent their massive Anti-Aging Advanced package twice on myself for $800 each time (out of pocket): hundreds of tests); I light up on about a dozen of their anti-neuronal antibodies in their Neural Zoomer Plus panel: obscure antibodies that my neurologists have never heard of. My antibody tests are still abnormal despite significant improvements in my health status.
I'm convinced that the study of food intolerances is a subject for 23rd century medicine. I hadn't realized how impossible this research is until I read some of Alessio Fasano's research (Mass General; Children's Hospital.) The phenomena involve complex interactions between the gut's nervous system, immune system, microbiome, etc. Fasano’s research is heavily cited by Vibrant.
Heavy metals: uranium? WTH! I worry about contaminants in supplements. A lot of the ingredients are sourced in India and in China. Public health? What's that?
Fibromyalgia: the Covid pandemic may result in a greatly increased study of virally induced autoimmune conditions (after millions of Americans develop long Covid.) These conditions are extremely difficult to study, made worse by the lack of longitudinal data.
During the Covid era — no live partner dancing for me. My latest brain challenge involves gaming in virtual reality. I love ping pong in VR and also dancing, boxing, and climbing. I bought an Oculus Quest 2 headset in November. It really helps in coping with the pandemic.
7 April 2022: I read books mainly at bedtime and favor non-fiction. I'm currently reading Bad Blood by John Carreyrou. (Check out the rave reviews on Amazon.) Carreyrou is the same justifiably famous Wall Street Journal investigative reporter who broke this story. Carreyrou is one of those brave souls (like Silent Springs's Rachael Carson) who motivate you stand up and applaud. This book is high edge-of-your seat drama (and totally unsuitable for bedtime reading.)
I mention Bad Blood here, because the story has some relevance to this essay. Here are the points of tangency to Vibrant America. Vibrant is also a startup who's goal is to provide wellness testing to the general public. You should notice that Vibrant divides its tests into two separate categories: (vanilla) Vibrant and Vibrant Wellness. The former provides a large array of conventional tests (similar to Quest and LabCorp) that it runs on "big machines" of proven accuracy from major equipment providers (no problem.) These are CLIA-certified, FDA approved, and Medicare reimbursable. In contrast, the tests provided by Vibrant Wellness are run on their proprietary microarrays. These have only been tested on small control groups, are not FDA approved and are not reimbursable. So, buyer beware; but, unlike the infamous advertising for Theranos, the blurbs from Vibrant are upfront about the limitations of their tech.
I always welcome substantive comments on this and all my essays. Please send email to bob AT bobblum DOT com. With your permission I may include excerpts here (always modifiable by you.)