One of the most foundational tests I suggest to clients to get done, is a micro nutrient panel. My current favorite is by Vibrant America, and covers 43+ Vitamins (A, B1, B2, B3, B5, B6, B7, B9, B12, C, D, D3, E, K1, K2, Inositol); Minerals (Magnesium, Potassium, Calcium, Zinc, Manganese, Selenium, Copper, Iron, Chromium, Choline, Potassium, Sodium ), Anti Oxidants (CoQ10, Glutathione, ); Amino Acids ( Leucine, Iso-leucine, Valine; Glutamine, Serine, Asparagine, Carnitine, Citrulline, Cystine, and Arginine) and Fatty Acids (Omega 6's: Linoleic Acid, Arachadonic Acid; Omega 3's: EPA, DHA, DPA) as well as MMA, white cell counts, and some functional ratios. This test looks at the levels in our blood serum (which is an indicator of absorption from the GI tract for the last 5 days or so - does our GI tract absorb nutrition from our food and supplements?). Perhaps more importantly, it also shows intra-cellular levels of these same elements, once in the blood, do our transporter genes for each element succeed in getting them across cell membranes into the cell for use in cellular processes ? The latter is a marker for longer term nutritional/functional status - 3 to 4 months. It also helps inform which genes may be compromised because they don't have the fuel (co-factors) to function well, or which genes are being way up/down re-regulated and burning through co-factors resulting in nutritional deficiencies.
I find almost every client has at least some significant deficiency somewhere. Many clients that find me, have gut and digestive related issues which often drives a whole host of malabsorption related issues. Needless to say, correcting a clients nutritional status is low hanging fruit, with very low potential for side effects, and high potential for significant gains, at a very modest cost. Often clients feel effects within hours or days of addressing deficiencies, for others its a few weeks.
Mal Absorption - Gut Issues
Nutritional deficiencies can manifest for a multitude of reasons - for many its gut related mal absorption. Perhaps they have low stomach acid production, and low pancreatic enzyme production. Phenols inhibit lipase production in the pancreas - addressing diets high in phenols (coffee, herbs, etc) often helps this. For others its a build up of oxalic acid (tested using an Organic Acids urine test), that must be addressed gradually over time. Foods commonly high in oxalates are : spinach, beets, nuts, celery, dark leafy greens to start. See this LINK for a good list to check out. Poor absorption can also be from gut dysbiosis in the small intestine, often SIBO (small intestinal bacterial overgrowth), candida, or both. Poor absorption can also be due to compromised gut lining, from poor nutrition, inflammation, and bad gut bacteria, to name a few.
Mal Absorption - Genetics
For each nutrient, there is a transporter gene that carries it across the gut wall into the blood stream. This is the first level of 'absorption' into the body. Many people have compromises here for certain nutrients. I look at genetic factors for absorption of : A, all the B's, D, E, K1, K2, Zinc, Phosphorous, Magnesium, Choline, B3, B2, B5, B7, B9, B12, B6. If we have a genetic issue that keeps us from using the gut as pathway for nutrient absorption - we need to find another work around such as topically, liposomal absorption through mucous membranes in the mouth, epsom salt baths, and even nutritional IV's. My own personal issue here was magnesium, which is a common co factor in so many bio chemical reactions in the body. Once i identified this and began using epsom salt baths, topical lotions, and nutritional IV therapy my health made a significant jump.
The second level of absorption into the body is from the serum blood across red and white cell membranes and inside these cells. This is why i like the MicroNutrient panel so much - you see what gets inside the cell. And again, there are specific genetic transporter genes that get each nutrient into the cell, and then actually different transporter genes to get the nutrient out of the cell too. Many people have issues here with B1, B2, B6. It is very common, and also common with zinc. Having the capability to look at the genetics at this level, and also functional lab markers lets me really dial in nutritional interventions that will work and support clients successfully. Many people struggle with clearing B6 from the cell, and it can be neuro toxic, so for these folks, this is monitored closely and frequent small dosing is used to enable function.
Additionally, many of the genetic markers for nutrition give us information on which form of the nutrient will be best for the client. Often we see a certain step in breaking down the nutrient into useable forms is compromised - this is another area where we can really dial in nutritional therapy. And some forms of nutrients are able to cross the blood brain barrier, as one example, while others are not. If I have a client with major gut issues, mal absorption, and genetic issues, usually i will start them with liposomal multi vitamins for the first few weeks to ensure basic nutrition and to by pass any potential blocks with absorption.
Often I have clients come see me that want to get started on tackling some particular issue that may be quite intricate and complex in nature. And often, these same clients have significant nutritional deficiencies , that once addressed, the intricate complex issue they came to see me about, resolves:).
Not only do i use genetic data and look for mutations to see where compromises may exist that effect nutritional absorption, but genetics also gives me clues which pathways may be up regulated or down regulated requiring more or less of some nutrients. I look at dozens of complex bio chemical pathway maps where i have identified co factors for the more significant enzymedic reactions in the body. It is often easy to see why some symptoms have manifested given nutrients that are required for gut function, neurotransmitters, breaking down amino acids, are below functional status. You might imagine the intelligence of the body at work here, knowing its short on some nutrients, it may create its own work arounds, and begin shutting some processes down until the nutrient that is in short supply is restocked. It is my belief, that this is often what we must un wind with nutritional based therapies when significant nutritional deficiencies exist.