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 of 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.