Thankfully more and more practitioners offer nutrient tests. Yet they can be tricky. Not all tests are helpful and not all results can be taken at face value.
Here are five standard tests that can be highly misleading and how to better understand them.
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Serum calcium is part of a chemistry profile on nearly every lab order. There are two misleading parts about calcium. First is that calcium in the blood does not relate to nutritional status. Low blood calcium does not mean one needs to consume more, and high blood calcium does not mean consuming too much.
Serum calcium is critical. If it cannot be kept within a narrow window, nothing works in the body, including cardiac function. That is why many mechanisms, including intestinal absorption, parathyroid hormones, renal function, and bone metabolism, carefully regulate it.
When serum calcium is high or low, the regulation is not working correctly. The solution will not come from adjusting calcium intake.
The second big problem with calcium is that it can be excessive even when within the normal range. Most labs consider it normal up to 10.4 or 10.6 mg/dL, yet once it reaches 9.8 mg/dL or above, something might be wrong.
Anyone with calcium above the range or consistently over 9.8 should be evaluated for hypercalcemia. The leading causes of it include abnormal parathyroid function and malignancy.
I have seen far too many patients with high calcium who were told they needed to consume less calcium. I have also seen many more who had high-normal calcium and were told they were fine when, in fact, they were suffering from hyperparathyroidism.
There are many ways to measure iron, including red blood cell (RBC) levels, serum iron, total iron binding capacity (TIBC), ferritin, and % saturation. One problem with iron is that many of the markers only show a deficiency when it is severe. Most experts agree that, of the commonly available markers, ferritin is the earliest to show a deficit.
Another big problem is that inflammation can skew iron. One of the most common things that happen is that chronic inflammation causes the body to move iron into storage. Inflammation makes ferritin higher, even if the overall iron levels are low.
Iron can look elevated even when it is not.
Many people who monitor their labs pay attention to their ferritin. However, it is essential to remember that an accurate analysis requires the context of all iron markers.
I have seen many patients who were told their iron levels were fine when they were, in fact, deficient. I have seen many others told they have too much iron when, in fact, they had too little but had false elevations from fatty liver disease.
Manganese is part of several comprehensive nutrient panels. When people are measured for manganese, some will have higher levels than others. By definition, a small number of people will have levels that are much lower than anyone else.
Yet actual deficiencies of manganese have never occurred. I have seen people develop thyroid problems secondary to high doses of manganese, which was prescribed based on nutrient tests. More on this one later.
Vitamin D has two main problems. First, it is reported in two different units, ng/mL or nmol/L. The latter is more common in research articles and international lab results. The former (ng/mL) is most commonly used in lab results in the US.
The conversion is that nmol/L is 2.5 times higher than ng/mL.
What has happened is that many health experts have read studies written in nmol/L and used these numbers to make recommendations for blood levels in ng/mL. I kid you not. A study might suggest that optimal vitamin D levels range from 75-125 (nmol/L). Health experts have then told their readers that their blood levels should be in the 75-125 range, WITHOUT mentioning that their blood results will likely be in ng/mL.
75-125 nmol/L = 30-50 ng/mL.
The other problem with vitamin D is that it is a negative acute phase reactant. That means that when someone is sick, their vitamin D levels drop. People with weaker immune systems, thyroid disease, fatty liver, or autoimmunity also have lower vitamin D levels. However, that does not mean that low vitamin D causes these problems or that vitamin D supplementation can help them.
Let’s use fatigue as an analogy. If someone is sick, they are likely to walk fewer steps in a day than a healthy person.
If you took a group of 500 people with nearly any disease imaginable, they would likely walk fewer steps per day than 500 similar people without that disease. You could imagine that might be true for ovarian cancer, chronic lung disease, or acute COVID. Let’s say that people with these diseases walked, on average, 300 fewer steps per day than people of the same age and gender who did not have the condition. It would be no surprise if a clinical trial were done to see if walking an extra 300 steps per day cured ovarian cancer.
That’s about where we are with vitamin D.
The truth is that we do need vitamin D and that many people are too low in it. It is also true that in nearly any illness you can imagine, vitamin D levels run lower. Yet countless studies have shown that high-dose vitamin D supplementation does not cure much of anything.
Iodine tests also have several issues. The main problems are that they need to be more precise, they are not clinically relevant, and they do not measure what is expected.
Nearly all misuses and misunderstandings about iodine can be traced back to the incorrect use of iodine tests. I’ve seen countless people have their health ruined because a practitioner used iodine tests that they did not understand.
The most commonly used iodine tests are serum iodine and urinary iodine. Serum iodine does not measure the amount of iodine in the thyroid. It measures how much is left after the kidneys eliminate it.
Serum iodine is only helpful in evaluating someone for severe iodine toxicity. A healthy person may have normal or low serum iodine. If someone is exposed to toxic amounts that are so high they damage the kidneys, then serum iodine might elevate. I’ve seen countless times where practitioners use serum iodine as a basis for iodine supplements.
The problem is that they keep putting their patients on higher and higher doses and can’t figure out why their serum levels don’t rise. They assume the person must be badly deficient when the problem is that they are misusing the test.
Urinary iodine is an accurate test for nutritional status, but only when analyzing a population. Any given person’s urine iodine level varies widely from one moment to the next. Some things measured in urine rise and fall throughout the day. In these cases, a 24-hour urine test can be more accurate than a random urine test.
Using 24-hour collections instead of single samples barely improves the accuracy of iodine tests. A random or 24-hour urine test requires several hundred samples to be within 90% accuracy.
The last problem is clinical relevance. It would be logical to think that people whose tests showed high levels of iodine would most likely benefit from low-iodine diets. But this is not the case. In some of the studies in which low iodine diets reversed thyroid disease, there was no clear relationship between urinary iodine levels before the diet and those who improved after the diet.
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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.
Dr. Alan Christianson
Alan Christianson is a Naturopathic Medical Doctor (NMD) who is a board-certified Naturopathic Endocrinologist with a focus on thyroid disorders. He is the author of The Metabolism Reset Diet and the New York Times bestselling book The Adrenal Reset Diet.
He founded Integrative Health, a physician group dedicated to helping people with thyroid disease and weight-loss resistance regain their health.
He has been named a Top Doctor in Phoenix magazine and has appeared on national TV shows and in numerous print media.
Dr. Christianson resides in the woods by a lake in Northern Minnesota with his wife Kirin.
