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The 5 Most Misleading Nutrient Tests
July 11, 2022
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Home > Energy > The Problem with Nutrient Panels

The Problem with Nutrient Panels

Wouldn’t it be great if all health problems could be solved by vitamins? I wish that were true. There are countless situations in which diet and lifestyle changes improve health. There are many situations where poor quality diets lead to health problems.

Nutrient testing has a natural appeal. The majority of us have troublesome symptoms that come and go. Often these symptoms lack good solutions. There may be no explanation for them. Even when there is, all too often there is nothing that can be done, or nothing that would not entail side effects or unreasonable time or expense.

Who would not want to find out that all of their chronic symptoms could be solved by a safe, inexpensive vitamin?

Natural practitioners are taught a compatible set of ideas. Many of us come to expect that every health problem is caused by some degree of a nutrient deficiency.

 

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Table of Contents

Nutrient Testing
Precision
Accuracy
Clinical Relevance

Nutrient Testing

We now have vitamin and mineral test panels available that measure every conceivable nutrient.

First I’ll talk about the 5 most misleading nutrient tests, then I’ll explain why nutrient panels are inherently problematic.

If newer practitioners run these panels on their symptomatic patients, they see that they do have nutrient deficiencies – often several. Practitioners will also notice that there are many cases where giving nutrients based on these results seems to improve symptoms.

The patient tells the practitioner that they feel better, and the practitioner experiences a win. The beliefs are easily reinforced for all parties involved. Over time, contradictory evidence mounts. After working with people for longer periods of time, many who felt better at first start to relapse. After seeing the results of enough of these nutrient panels, it becomes clear that everyone tested had several deficiencies.

Yet the initial reinforcement of the beliefs makes them resistant to contradictory evidence.

I had some odd experiences early in my career that made me less apt to get stuck in these ideas.

My first exposure to one of the popular nutrient panels was through a patient of mine. He and his wife both came to see me as new patients. He was a salesperson for a vitamin-testing company. They wanted me to screen them for overall health including the tests from the company he worked for.

I was not yet familiar with the test but had no objections. It measured about 30 nutrients and claimed to determine their functional levels within the cells.

It is worth noting that he had few symptoms or complaints yet his wife had many.

When their results came back, he had only a couple of nutrients below ideal. His wife’s results were a mess. Nearly half of the nutrients were off, many by large degrees.

Yet their regular blood chemistry was quite different. Hers showed a healthy enough woman with early thyroid disease. His showed severe liver disease and were suggestive of late stage metastatic cancer.

Of course, blood tests alone can’t determine such things, but as he did further tests with the doctors I referred him to, my suspicions bore out. He died a few months later of stage 4 liver cancer.

My first experience with nutrient panels made me suspicious. Of course nutrient levels were never meant to be diagnostic of cancer. But it did not seem right to me that someone whose body had lost the ability to regulate itself should be in ‘better’ shape than a healthy person.

A few months later, other representatives of the same company approached me with hopes of getting me to use their vitamin tests. They offered to let me run a test on myself at no charge. I was skeptical for reasons in addition to the husband and wife’s results.

My first few months of practice were at a center that owned a medical clinic and a new testing laboratory. In addition to patient care, I was aware of the behind the scenes realities of blood analysis. I knew it was not a perfect science.

I accepted the offer to have my vitamin levels measured, but I wanted to use it as a test.

In our laboratory, the easiest way to see if the machines were working well was to analyze the same sample twice. Most blood tests require a small fraction of the blood that was collected in the test tube. That made it possible to re-run the test on the exact same sample.

You might be surprised to know that the results are rarely if ever identical in these circumstances. Yet they should be close. Often they were not and it meant there was a problem with the process. This test was called a split sample and it is a common tool in reference labs.

A split sample measures precision – does the test get the same results on the same sample? If the results are not precise, they are meaningless. If they are precise, there are more hurdles remaining. They must also be accurate and clinically relevant.

Clinically relevant means that the results direct the treatment into a helpful direction. Not all labs do this.

Imagine a bow-hunter. A precise hunter’s arrows always hit the same spot. It might not be the center of the target but they all end up close together. An accurate hunter’s arrows cluster around the center. A hunter who is precise and accurate gets all the shots close to the center.

Imagine a hungry hunter who goes out in the woods. A dozen well-paced shots into a tree won’t feed his family. They might be precise and accurate, but they are not relevant.

Precision is not everything, but it is easy to measure and without it, the test is useless.

Precision

When I was offered a test for myself, I decided to do a split sample. Each test required two tubes of blood, we drew four. We put my name on two randomly selected tubes, and our nurse Mitzy’s name on the other two. Since they were all from me, Mitzy and I should have got the same results. We did not. Not even close.

Over the following years, more and more of my colleagues used this test. I did not and our paths started to split.

They started adding more ‘functional’ tests into their repertoire. I became more skeptical and looked at all of the tests I used even more carefully. Back to nutrient tests, functional lab tests in general is a story for another day.

Accuracy

An inherent difficulty with measuring nutrients is the fact that they are carefully regulated.

When an engine is turned off, you can pull out the dipstick and see how much oil is in it. When the engine is running, oil is being pumped all over. It won’t look low on the dipstick unless there is none there.

Nutrients are similar. The body works hard to keep the right amounts in the bloodstream. Nutrients are often used in rapid chemical reactions that take place inside the cells. Measuring them is like measuring oil in a running engine. You might find readings that are high, low, or normal. Yet they only reflect the fraction of time in the tiny bit of blood that was measured. It may say nothing about the overall state of the body.

When nutrients are measured as part of large panels, small problems are amplified. Many nutrient panels include 10-30 different measurements. For any one of these measurements, an error rate of 10% would be exceptional, 25-30% is more common.

What that means is that, in the best case scenarios, 1-3 of the results are purely random (10% of 10-30). In typical scenarios, 2-9 results are random (25-30% of 10-30).

Imagine a perfectly healthy person with no nutrient deficiencies had 30 of their nutrients measured. It would be most likely that their report will list several deficiencies.

This is a problem inherent to running lots of tests. The more things you test, the more likely it will be that some of your results are meaningless.

It often seems like a badge of honor for a doctor to test more things. It seems like if they really care and are trying hard to help, they will run more tests. The better educated doctors do fewer tests. They know that the more tests they run, the more likely it becomes that they will put time and energy into meaningless results.

Clinical Relevance

Tests are only good when they guide treatment in ways that would not otherwise happen. Results can be accurate and precise, but not relevant.

Relevance can only be determined by taking into account the population tested and the results of intervention.

Imagine you are testing a person’s level of a nutrient, but no one in the population is deficient in it. Manganese can be a good example. We usually define a level as abnormal if it is higher or lower than 95% of everyone else that was tested. This is the range of 2 standard deviations on the image below.

A popular trend in functional medicine is to define ‘functional ranges’ for lab results. These are usually just a narrower window on the normal range. Rather than 95% for the cutoff, they might take 68% or one deviation.

Again, this seems noble. It seems like they are trying harder to find problems, not ignore them.

Let’s say you are screening a population for stunted growth. You wish to identify those with stunted growth so that you can improve their nutrition and help prevent further problems. If you define stunted growth as anyone below one standard deviation, you’ll get a lot of perfectly healthy people who are slightly shorter than average.

Imagine you run the test above on a group of NBA players. They will also follow a distribution like above, some are taller than others. There will be some who are 3 standard deviations below average but they won’t have growth stunting! They will probably still be over 6’6” tall.

Applying this to nutrients, if an American’s levels of manganese are lower than 99% of other Americans, it does not mean they are deficient. It can just be normal randomness.

Take Good Care Today

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P.S. Whenever you are ready, here is how I can help you now:

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Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet, The Metabolism Reset Diet and The Thyroid Reset Diet.

Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, diabetes, and regain energy. Learn more about the surprising story that started his quest.

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