Vitamin Deficiency Testing: Find Out What You Are Actually Missing

If you're joining us live, welcome. Uh, this is the MedMatrix Method podcast. We're going to be talking about two really exciting subjects today. Uh, hormones and vitamins, specifically how to optimize them, what does it mean to be deficient in some of these things, what are the strategies you can do in your day-to-day life, what are things that you can do with cutting edge medicine, working with a practice like MedMatrix. Um, none of what we say is medical advice. This is for educational purposes only. And if you're interested in working with MedMatrix as a patient, you can go on over to medmatrixusa.com and click get started. All right, so um first we're going to kick things off by talking about um vitamin deficiencies. So Dr. Rose, um welcome. Thank you for making time after a busy day. Appreciate it. Welcome. Happy to be here. Yeah, if you can't tell, uh if you're just listening on audio, Dr. Rose and I are matching. We're wearing the same sweater. Yeah, we got some new merch. We love merch. Um, so yeah. All right, guys. So, uh, Dr. Rose, why don't you talk a little bit about vitamin deficiencies? What are vitamin deficiencies like actually? Well, um it vitamin deficiencies are when for a variety of reasons an individual is not getting sufficient or optimal levels to help with the body's normal um metabolic pathways, hormonal pathways. Um, so kind of like I think of it as like working with a handicap and usually people don't know that they have vitamin deficiencies. So it's kind of like going through your daily life with um, you know, with a handicap with a with kind of extra, you know, weight around your ankles. Um, not feeling great but not knowing why. not knowing that um at least part of that might be because of certain vitamin deficiencies. Um so again there can be a number of reasons. Um it can be anything from um the the food that one is eating the you know where that food was grown if it's plant-based um to issues with gut health and absorption of said vitamins and minerals. Gotcha. Okay. So, a lot of questions here because a lot of people take vitamins trying to solve for deficiencies, right? They just kind of, oh, I should take vitamin D. I should take some magnesium. Um, what just curious like because a lot of patients before they come to the practice, this is their first kind of experience with more in-depth blood testing. Um, how often are patients deficient in a vitamin they're still taking? So, one thing I do want to clarify is that we have vitamins and we have minerals. And so, I think what we're talking about here is kind of both. Um, and we, as a general statement, kind of standard American diet, we tend to be more deficient in minerals than we are in vitamins. with some exceptions like I think we're going to dive a little bit deeper into things like vitamin D and some of the B vitamins, but in general um Americans as a whole tend to lack minerals more than vitamins and largely that's because we don't eat enough plants and plants are really rich in in minerals. Um, so some minerals people are familiar with things like magnesium and calcium and then there's some of the lesser known ones maybe like selenium um chro chromium things like that which we also really need. Um, so I just wanted to make that clarification. Um, but I think your question was how often is somebody kind of already supplementing with vitamins and or minerals but they're still deficient? Is that the is that pretty much um I mean just clinically I would say fairly often. Um I see a lot of people taking multivitamins and I think there's pros and cons maybe or it's better to say um sometimes people are using a multivitamin maybe not in the best way is a maybe a clearer way to say it. Um, so I am not in general like a huge fan of a multivitamin as a way to kind of like just take care of everything, right? I think that if what I usually tell people is if you are in a place in your life when you don't know how or you are unable to eat a wellbalanced whole foodsbased um diet, right? And so you're either knowingly or not knowingly kind of malnourished, just not eating enough plants, just not eating a variety, etc. Then a multivitamin might be the right thing for you. Or like maybe you're a parent and your your child goes off to college and they're just not eating great. Like the food in the dining hall isn't good or they're just like not treating not really eating the way they did when they were at home. maybe that's a good time to take a multivitamin. Um, but what I really like about our testing and our ability to test is that we can get really specific in what where is where are the deficiencies? Um, is it a magnesium deficiency? Is it a vitamin D deficiency? Is it an iron deficiency? And then target based on that. So, it really is really individualized. Obviously, the best thing is food as medicine and to get as much as we can through our food. Um, but unless we're testing, we don't really know what somebody's deficiencies are. Okay. Let's talk a little bit about getting vitamins and minerals through our food because can you tell like talk more about kind of what's happened to nutrients and the soil and food over time because that's a problem, right? I mean, we're not able to get the things we need through our food anymore. How much of that is true? How much of that is not? Yeah. I mean, I think I'm not a farmer. Like, you know, um agriculture is is not my area of expertise, but I think we all have some level of understanding that the way that um our food is grown is different than it was a hundred years ago. and um you know even the fact that food is shipped across the country or across the world um and we just we just eat very we we no longer eat locally um and we don't really eat seasonally either. And so we're all accustomed to getting an avocado any time of the year. Now avocados are not native to Maine or anywhere around here and certainly not in winter. So, um, where there's just a level of that kind of like you want what you want, you can get it anytime and you can walk into any supermarket and you can get it. But I think that there are some things that have been lost with that. Um uh so I'm kind of digressing a little bit, but um I think that there's chemicals that are used now um with food production that are impacting everything um including our health. And um in some ways like depleting uh these food sources from the nutrients that you know if again if we were if if food was grown the way it was 100 200 years ago it would be that would be it would not be an issue but things have just shifted to such an extent that we're not really getting that richness like we did. Gotcha. All right. So let me let me ask that a different way. So, would it be possible to be 100% optimal with your health um by just eating good food? I see what you're saying. Or do or or do you have to take supplements if you want to be as healthy as possible? No, I think that if um well, everybody's makeup is different, so it's hard to make a general statement. Um but no, I think it is possible to get everything you need through um your food. Now again, vitamin D, unless we So if somebody were to eat the way the Norwegians eat or used to eat where you're eating like fatty fish twice a day, you probably are going to get, you know, vitamin D um and great omega-3 fatty acids through your food. But most, again, most Americans aren't eating that way. Um, and you're not going to find vitamin D in other food sources. I don't count like fortified milk as a really an option. Um, so, um, but for the most part, if somebody were really conscientious and, um, had a super balanced, well-rounded, lots of variety, um, lots of plants, lots of fiber, yes, they could get what they need through food. Cool. Okay. Um, so how can is it possible that two of like the exact same physical person, so same gender, same weight, um, same age, can eat the exact same diet and have different vitamin levels and mineral levels. Yeah, absolutely. Because your gut microbiome is different. You can be the same same sex, same height, same weight, but your gut microbiome is different. So, the way that you actually absorb, break down, utilize your food and therefore your nutrients is going to be different. Um, and your everything, your level of um like where your nervous system is, well, you know, your nervous system is going to need B vitamins. Like if you're really stressed out, then you're going to be kind of soaking up all that B12 and you're going to potentially be at more risk of being deficient. Somebody who's not living with kind of a certain level of chronic stress, then they're not going to be as at risk for a vitamin B12 deficiency. Okay. So, that kind of leads me right into my next question, which is um when someone has vitamin deficiencies, how much of treating it is giving them a supplement where they're deficient, and how much of it is treating the absorption and their gut health and their gut's ability to absorb and use, you know, nutrients. Yeah. Yeah. I mean, both. I'm I'm just a real big fan of doing things concurrently. So, treating the gut, treating the nervous system at the same time. um giving them the minerals, the vitamins that they need so they can start feeling better now like while we do kind of the longer what takes longer the longer range work of like restoring the gut gut microbiome and gut health. Gotcha. Okay. So, what about all the people who've like gotten the online testing? Like I think function health is probably one of the big one. I know there's a lot of them now once they came out and they, you know, see where they're deficient. Now they're just taking a bunch of like supplements based on where they're deficient. Are those people going to run into problems because they actually have a gut issue where they're not absorbing it properly? Potentially. I mean, it's like it's there's so many layers to this medicine, right? I mean, we talk about root cause medicine and um kind of digging deeper and that it's not you can kind of keep going, right? So one one layer deeper than um conventional medicine would be doing that level of micronutrient testing which is fabulous. That's great. But then the next level is well why why are you deficient? And and then you know getting in again getting into gut health getting into whatever is going on like with an autoimmune condition or hormonally or nervous system or whatever it is and you can kind of keep going and that's where it's individualized. I think that's where it's like, you know, what is this patients this individual's bandwidth? Um where what's their what are their priorities? Like at what pace do you go? Some people like want to dive in. They want to do all of it right now. And most people are kind of like let's just kind of bite off a little bit at a time. Um so somebody who does that online that testing and then takes a bunch of supplements. Um there's also the question of well how much do you take right of of said mineral or vitamin? Um they will probably feel better which is great but as I think you're pointing out uh we're not really answering that underlying question which is why are they not absorbing it or why do they continually why are they still um deficient in iron, right? like they can supplement with iron and they can their energy can be better but why why that deficiency in the first place? Mhm. Okay. So deficiencies as we know now can be a result of poor absorption in the gut. What about genes? Like you've heard a lot of talk about like methylation. Um can you talk a little bit about that? Like what is methylation and um how yeah how does that play a role in you know one's ability to absorb the nutrients they need? So, the one test that a lot of people have heard of is the MTHFR genetic mutation. That's kind of one of the most well-known um SNIPS or genetic mutations. And what that there's a lot of other ones that can be tested for, but that's kind of one of the primary methylation um variants. So, what it is is it's like if you have so it's genetic. So if you have a a genetic um mutation or a genetic variant, that means that the way that you basically process um B vitamins, for example, is going to be different. That your um when you take in B vitamins through your diet, through a supplement, your body has a harder time methylating. And so what methylating is or the methylation process is basically a process where those B vitamins can kind of be converted and actually utilized. So if that's if there's a handicap there and the body is not able to methylate easy easily then you could take all the B12 like you can get the highest quality B complex in the world but your body kind of doesn't know how to use it or doesn't use it as well as somebody who doesn't have that genetic variant. Um and so you see things like elevated levels of homocyine which is an inflammatory marker. you see a deficiency of glutathione um which is like a really potent um antioxidant and kind of helps with detox pathways and inflammation in general. So those things are going to be kind of compromised when um somebody has that that variant. So one kind of I guess you could call it a bio hack is like you when you take a B vitamin you take a methylated version or if you take any vitamins you take the methylated version. So they're already in a form that your body can utilize more easily. Okay. Gotcha. Because there's a lot of hype around methylation and y a lot a lot of it was Gary Brea. A lot of it was Gary Brea and and it even impacts estrogen metabolism as well. So it it's Yeah. But a lot of it was Gary Brea. I agree. Gotcha. Okay. Um, so can we talk a little bit just about like conventional like your primaries cares approach to treating vitamin deficiencies versus a functional approach functional medical approach to treating vitamin nutrient mineral deficiencies? Yeah. So, I mean, I don't want to put all primary care providers in one basket because I know that they there's a just like all of us, all providers is a huge range. And, you know, over the years, I I have known primary care providers who do say somewhat routinely test for vitamin D, which is great. Um, that and maybe B12. Um, but that said, nutrition in general is not taught in medical school, in conventional medical school. Um, and it's just not part of the training. It's not usually part of kind of their toolbox. So, um, just to have that as a background, it's kind of, I guess, can at least traditionally not even on their radar to kind of test for deficiencies. um unless it's something yeah just for standard kind of routine care that's just not something that they're going to really think about. Now there's some exceptions like if you know some they suspect somebody's anemic they're going to test your iron level um and maybe your feritin hopefully which is your body's like reserves or storage of iron. Um but so first of all it's just not really on their radar. It's not really tested that much. And maybe because in functional medicine we do have more training, more awareness of nutrition in general that includes encompasses minerals and vitamins and kind of checking for those micronutrient levels. Does that make sense? Yeah. Gotcha. And what about the ranges though? Because you go to your Oh, yeah. Okay. And then there's that. So, um there's this is kind of a classic normal versus um optimal difference. Um so, vitamin D is a good example. Um there's a lot of kind of fear I would say in conventional thought, conventional medical thought about vitamin D toxicity. And part of that is that vitamin D is a fats soluble vitamin. So we don't um it can technically kind of be stored in the fat. We don't unlike the B vitamins which are water soluble. We kind of pee out you know um water soluble vitamins. You don't really have to worry about like toxic levels. U but vitamins A, K, E, D, those are fat soluble. So um there's this kind of fear around someone taking too much vitamin D3 and um they will say that a normal level is like 23 and this is I think nanogs per milliliter is the are the units that I'm referring to. So um for me and most of us in functional medicine if somebody comes with a in with a vitamin D level this is serum or blood that we're talking about at 22 23 that's deficient. Um maybe not technically but it's certainly like suboptimal. Um, so that person is just that's impacting everything from thyroid to neurotransmitters to bone mineral density um to immune function, right? Um, our goal usually with a serum level of vitamin D is like at least 60, anywhere from like 60 to 80. Some other practitioners will say even higher. you don't really have to start worrying about toxic levels until you get close to 150 nanograms per milliliter. And in my clinical experience, that's really hard. That's really hard for someone to get to that level. Um, so there's a that's one kind of good example, I think, of a difference between normal versus optimal. Um, in terms of levels, it's it's Yeah. Gotcha. Makes sense. Okay. So, um, diving into some of the show note questions here. Um, can stress, trauma, chronic illness essentially, um, maybe burn like burn through nutrients faster or like make you more prone to deficiencies? And if so, which ones would be most affected? Yes. Um, primarily the first ones that come to mind would be uh, like vitamin B12. Um and then mineral-wise, magnesium. So both um B12 and magnesium are like fuel for the nervous system and the adrenal system. And so when you are when you've experienced trauma, when you've experienced stress of any sort, the nervous system, the adrenal system, they need that's what they that's how they're kind of surviving, right? Like that's what they're running on. But there, yes, I guess you could say burning through those that vitamin that mineral more than a person who's in a more relaxed um state would. So, you're much more prone to become deficient. And you're getting those through food, maybe through supplementing. Um, but it's a pretty common picture, unfortunately. Gotcha. Okay. Um, so how do nutrients uh and minerals, vitamin deficiencies play a role in your mood and your energy and your motivation? And if so, like what are the most common offenders when it comes to the vitamins that are really important in just the way you feel? Um, I mean, probably all of them. you know, the ones that we kind of look at first would be ones that I've already talked about, but um vitamin D definitely in terms of mood regulation, you know, it's kind of classic. Like part of the reason, you know, in the fall and this time of year, why I'm really aiming for all of my patients for their serum levels of vitamin D to be as close to 60 or higher is because of things like seasonal affected disorder and the fact that the days are shorter and a lot of people are really affected by the lack of light. And so having it's having optimal levels of vitamin D is one way to help um alleviate that to some extent. Um and um the and the yeah I mean if you're if you're stressed if you're tired uh you know kind of a a B12 a B complex is going to be is going to be big. If you have muscular tension if you're stressed then magnesium is going to be really important. Um, and if you're tired, we're we're largely looking at like iron and that and sometimes that can be it can kind of bleed into more of like a depression, you know, kind of that fatigue, depression, malaise. Sometimes it can be a little hard to tease those apart. So, those are all again, it's like how I what I said in the beginning. It's it's like walking around with these handicaps that are essentially kind of lowhanging fruit in terms of fixing them. Again, we want to dig deeper, like, you know, we want to deal with the trauma, we want to deal with whatever the underlying issue is, but it's pretty easy to replenish those micronutrient deficiencies. So, even though it's probably a complex situation that like that's one thing that you can do quickly and people every day people say, you know, they come in for their vitamin D injections and they're like, I felt a difference immediately. Um, I had a woman yesterday who she when she came to us, her vitamin D level was under 10. I think it was like 9.71. And again, our goal is 60. And so that is technically deficient. That's not just suboptimal. Um, and so I had her come in once a week for an injection and she would leave every time just feeling so much better. Um, and you know, we were only in three two and a half months, we were only able to get her serum levels up to 23, but again, it's better. Um, but we we have a little bit more work to do there. Just curious, what did that patient know anecdotally as far as like the way she felt after just like more energy? Energy. She just felt better. She just felt like she wasn't dragging and um just like her like you like mood her just her mood just lifted. Gotcha. It's a good example. So, uh, hey guys, we we really appreciate if you're joining us live right now. We got about six more minutes left in this, uh, subject. So, if you have any questions and you're joining us live, feel free to, uh, drop them in the comments and we'll see if, uh, we can get to them with Dr. Rose. Uh, or just give us a thumbs up. We'd love to know you're there. If you are interested in becoming a patient, you can go to medmatrixusa.com and apply there. Um, okay. So, back into the show. How do uh vitamins, nutrients affect sex hormones? That's a good question. I mean, I referred to it briefly earlier in terms of estrogen metabolism. Um, so say somebody has a methylation mutation. They're taking B vitamins, but they're not methylating them properly. that's um kind of inadvertently or indirectly going to kind of affect estrogen metabolism. Um if this is an interesting one, we actually need cholesterol to make sex hormones. And so um like for example, if somebody's taking really high doses of a statin medication and they don't really have that much cholesterol, like that's going to affect their sex hormones. But from a nutrient perspective like we need healthy fats and that's gonna that's going to kind of provide building the building block for sex hormones. So can you explain more how like the vitamins actually affect like how like how like let's use vitamin D is that's one where everyone's like vitamin D vitamin D like but how does vitamin D actually affect the way you feel? Can you kind of break down the in terms of sex like the sex hormone? Sex hormon just like why is vitamin D so important in the way you feel? Um well because it affects your um it's like neurotransmitter balance. It has a role in terms of neurotransmitter metabolism essentially and um it affects your um like inflammation and so so a lot of this I guess I would say is a little bit like in my mind at least a little indirect right like you need these building blocks you need sufficient vitamin D in order to have lower levels of inflammation and in order to have optimal neurotransmitter metabolism and regulation. So, it's like part of the broader picture of um a healthy neurotransmitter response which is going to affect your mood. I know that might not be the most satisfying answer, but um it's like part of the big part of a bigger puzzle. to give context for this next question is like how many patients when they come in after doing you know a whole bunch of testing and they sit down with you for a full hour what percent of those new patients are deficient in some vitamin or nutrient or mineral um 90%. Wow. Okay. Pretty high. Um why do you think it's so high? So, it could be anything from um well, vitamin D. It could partly be because of where we live um and that we're not really eating again like we really don't eat fatty fish. Uh which would be helpful. Uh but largely it's kind of where we live. And then so part of it's how we eat. Uh again, circling back to kind of like the foods that we eat, how the how those foods are grown. and um gut health. And then there's things like iron, right? Does somebody have a gastric bleed that's undiagnosed? Is it a woman, a menrating woman who has really heavy periods and she's losing iron every month? Um is it a person who has a vegan diet and they haven't been kind of addressing making sure to get enough um iron supplementation? So, everybody's a little bit different, but um it's it's super common. And again, it's it's that also a difference between def like optimal, right? So somebody comes in with a vitamin D of 26, I'm going to treat that. In a conventional medical practice, they'd say that you're fine. So in my mind, they're deficient. Not every provider, you know, outside of functional medicine, not every provider would agree. Gotcha. Okay. And then to bring us on with this um this segment, can you kind of explain a treatment plan or a patient case study other than the one you brought up earlier uh regarding like nutrient deficiencies? Um yeah, I mean let's see. Um well, this is a pretty common scenario. Um I have I do have a fair amount of people who you know we go through all the blood work and we go through like the whole health history and there's like a lot of things that we can do as we've and as we've kind of said before a lot of for a lot of people it works to just kind of do one step at a time. So sometimes I'll just kind of do an outline with somebody of these are in general a lot of the things that that that we can do including you know your feritin is low, your B12 is low and your vitamin D is low. And sometimes what people say is well I think I just want to start with that. Like that's kind of I want to do take off like a small bite at first. Um so I will give you a specific example. Um, I have a a patient, he's he's um gosh, I don't know if he's 30, he's kind of late. I think he's late 20s and he kind of fit that picture where there were like a lot of different things that we could have done. And he um his like stress level was pretty high. Um he uh I think even like his cholesterol was a little bit higher than optimal but he was very deficient in um iron, ferotin. All of them the all the standard ones that we test. I think his magnesium level was fine but um B12 was low and D was low. And so he chose just to focus on that to kind of eat um to kind of bump up uh me, you know, animal protein, which would help with the B vitamins, take a B12, a sublingual B12. Um I had him come in for some of those weekly D injections for 6 weeks, and then switched him to oral vitamin D3. I always add in vitamin K with D3. The reasoning for that is that D3 is going to increase your absorption of calcium. You want that calcium to go to the bones, not to the arteries. And that's where vitamin K can help. Um, so I switched him after the injections, we went to 10,000 IUs per day of D3 with K. And then an iron like a chelated iron that's non-constipating and um would boost iron and feritin levels. So he did that for 3 months and then I retested those levels and saw him and the levels had all improved. It was the same thing. His vitamin D went from um he wasn't as low as the other patient. He was probably like I think he was around 20 and his vitamin D went to 40. Great. Still not at 60 but better. And um but most importantly he just felt so much better. And so it was like again lowhanging fruit like a few adjustments. Didn't really do didn't really take a lot but um it was a great first step. Great example. Um okay, two more questions popped in my head. So one one's about milk because milk is like infamously uh good for your bones, right? And uh high in all sorts of good vitamins you need, right? I honestly don't even know. I think vitamin um which which vitamin is milk famous for? Calcium. Calcium. Calcium and D. D and D. Yeah. Calcium and D. So like is that true? Like should you drink milk for strong bones? I mean that was one of the best marketing ads in the history of advertising, right? I mean the fact that like people still say that is amazing. Like the whatever lobbyists they had or marketing people did a good job. Um they I mean there's calcium in milk and they fortify it with vitamin D. There's just a lot of reasons why. So, I still it's in partly generational. Like, I have patients in their 70s who still drink a glass of milk with every meal. Um, and my I don't think milk is bad, but I think that I don't like that quantity of milk. It's like dairy is often really inflammatory for people. It can contribute to things like post-nasal drip and um kind of like kind of a excess mucus and flem. Um just inflammation like overall it's just not my favorite way to get calcium or D. You can get calcium through leafy green vegetables. You can get calcium through um almonds. Like you you know through legumes or beans like you really don't need to have milk to get calcium. You certainly don't need it to get vitamin D. Okay. So, what's the difference between getting a vitamin or nutrient through a supplement or getting it through a food? Like, is it really better to like try to fix your diet, get all the nutrients, or should you just take supplements cuz like it's the same thing. I think it's some of both, right? I mean, we kind of talked about this like I think yeah, in an ideal world, if you could really it's almost like your full-time job was was like optimizing how you eat, but that also means optimizing your gut health. um and kind of knowing what your baseline is and then optimizing it from there. Uh and knowing exactly where your food comes from, how it's grown, like yeah, I mean, you do like Yeah, we should all kind of work towards that. Just in all honesty, it's just not super realistic, I think, for most of us to be able to get everything we need through our food given just our the way that our culture and our lifestyles are right now. So, I don't I think it's good to have like a blend supplement when you need to and have that be like targeted supplements um in addition to, you know, eating a balanced diet rich in vitamins and minerals. Gotcha. Okay, sounds good. Um All right. And I'm going to I'm going to play devil for this last question. I'm going to play devil's advocate. I'm going to come at you a little bit. So, like why like why should someone actually spend, you know, a good chunk of money, get all this blood testing done, sit down with a functional doctor like you for an hour when they could just go take magnesium, vitamin D, calcium, B12, methylated B12 supplements? Like, why go through all this testing and effort and money? Um, obviously there's other things they can do, but as far as vitamin deficiencies, like why bother? Not everybody's deficient and not everybody you don't know unless you do the testing and unless you talk to somebody who's really seasoned in this, you don't know um you don't know if you're deficient and you don't really and you don't necessarily know that difference between like deficient versus optimal. And it's the conversation is held within the context of your health, your health history, what your what your energy levels are, what your sleep is like, what your stress level is like, what your digestion is like. So it's it's not like in isolation. Um so we don't all need magnesium necessarily. Probably most of us do, but until you really kind of test it, um you don't really know what your baseline is. And even like B12, like if somebody's like, I have all I rarely hear this, but I have as much energy as I want. I wake up in the morning and I feel amazing and their vitamin B12 on the blood test is low. they might not need B12, like they feel great. They're they're not stressed. Their energy is fabulous. So, it's you have to match the whole health picture and the symptom picture with the deficiencies. So, that's that's where we come into play and and we talk about, well, what are you eating and you know, so it's part of that broader conversation. Gotcha. Cool. All right, guys. Well, thank you for all who joined us live. We're about to transition into the next segment. Um, if you are watching recording of this and you want to become a patient, you can apply by going to medmatrixusa.com and clicking get started. Let's move on into the next segment which is hormone deficiencies.