Category Archives: Vitamins and Minerals

Vitamin D is the “sunshine vitamin”. We can obtain this vitamin from a few foods, but our body is also able to synthesize vitamin D when the skin is exposed to sunshine. In this article, we focus on the important roles that vitamin D plays in the body.

Healthy bones 
Most people are aware that calcium is essential for strong and healthy bones, but did you know that even if you consume plenty of calcium, it can’t play a proper role in the body if there is not enough vitamin D? This is because vitamin D is needed to promote calcium absorption in the gut, and it is also required for the body to be able to effectively use the calcium. In addition, vitamin D is required for the proper functioning of osteoblasts and osteoclasts–the cells responsible for ongoing bone growth and remodeling (1,2).

Vitamin D deficiency can lead to bone pain, with long-term deficiency causing rickets in children and osteomalacia in adults, as well as increasing the risk of osteoporosis and bone fractures (1).

Healthy muscles
Vitamin D is important for the normal development and growth of muscle fibers. Vitamin D promotion of calcium absorption is also important to prevent hypocalcemic tetany, which is when the muscle contract involuntary, leading to cramps and spasms. Healthy and strong muscles may also reduce the risk of fractures, particularly in the elderly, as healthy muscles reduce the risk of falls (1).

Inflammation and immune function
Vitamin D plays a role in regulating the immune response and controlling inflammation. The role vitamin D plays in controlling the levels of cytokines (small messenger proteins) is thought to also impact the association between vitamin D levels and bone health (3).

There are also possible links between vitamin D deficiency and skin conditions, such as psoriasis and skin cancer, as well as increased sensitivity to infections and autoimmune diseases (4).

Blood pressure control 
Vitamin D helps regulate the renin-angiotensin-aldosterone system (and thereby blood pressure) (1), but there is conflicting evidence whether or not vitamin D supplementation is a beneficial treatment approach for high blood pressure (5).

Cell growth
Vitamin D plays important roles in controlling cell growth and proliferation, with possible links to slowing tumor growth, but the evidence is mixed for the prevention and progression of cancer. Although there is growing evidence that adequate or higher vitamin D intake can reduce the mortality rate of at least some cancers (1).

Glucose (blood sugar) metabolism
Insulin is the hormone that is absolutely essential for regulating blood glucose levels, and it has been shown that Vitamin D helps stimulate insulin secretion from the pancreatic beta cells. In addition, adequate vitamin D levels can reduce the risk of insulin resistance. Reduced insulin production and insulin resistance are characteristics of type 2 diabetes; hence why many people with diabetes also have low vitamin D levels. Research has shown that vitamin D supplementation may help lower average blood glucose levels in people with diabetes, particularly if they are also vitamin D deficient (6).

Brain processes
Vitamin D is also important for a healthy brain, by aiding in the function of the neuronal and glial tissue in the brain. This is why cognitive impairment, dementia, psychosis, and autism have all been linked with low vitamin D levels (7).

Measuring your vitamin D levels
Checking your vitamin D levels is quick and simple. It just requires a simple finger prick blood sample with our Vitamin D Test. This test measures your blood concentration of 25-OH vitamin D, which is the main indicator of vitamin D status. This test can tell you if your levels are in the healthy optimal range, or if you have mild to moderate deficiency, or if you have a severe deficiency. It can also detect vitamin D levels that are too high (vitamin D toxicity), which can occur in people who take an excessive amount of vitamin D supplements.

For more information about vitamin D, see our previous articles:

• Signs of vitamin D deficiency
• What can increase the risk of low vitamin D?
• How can I boost my vitamin D levels?
• Are there links between low vitamin D and depression?

References:
1. Vitamin D: Fact Sheet for Health Professionals (Updated August 2021). NIH.
2. Bikle DD. (2012). Vitamin D and Bone. Curr Osteoporos Rep. 10(2): 151-159.
3. Laird E, et al. (2010). Vitamin D and Bone Health; Potential Mechanisms. Nutrients. 2(7): 693-724.
4. Bouillon R, et al. (2019). Skeletal and extraskeletal actions of vitamin D: Current evidence and outstanding questions. Endocr Rev. 40(4): 1109-1151.
5. Zhang D, et al. (2020). Effect of Vitamin D on Blood Pressure and Hypertension in the General Population: An Update Meta-Analysis of Cohort Studies and Randomized Controlled Trials. Prev Chronic Dis. 17: 190307.
6. Vitamin D: A possible ally in the fight against diabetes. (2018). McMaster University.
7. Anjum I, et al. (2018). The role of vitamin D in brain health: A mini literature review. Cureus. 10(7): e2960.

The short answer is yes, you can easily check vitamin and mineral levels from home. And all it requires is a simple self-collected finger-prick blood sample.

Why should you check your vitamin and mineral levels?
The Second Nutrition Report (1) published by the CDC found less than 10% of the U.S. population had nutrition deficiencies. However, specific deficiencies in certain populations are a lot more common. For example, vitamin D deficiency affects only 3% of non-Hispanic white people, but 31% of non-Hispanic black people.

Many nutrient deficiencies do not cause any symptoms in the early stages, but this is when they should be corrected so no health complications occur. Taking a simple blood test can indicate what nutrients you may need to increase intake of, either through dietary changes or by taking additional supplements.

Consider taking a vitamin and mineral test if:

• You’re affected by unexplained fatigue or other general illness
• You’re often affected by illnesses that don’t seem to affect others as much
• You’re experiencing mood changes or your mental health is affected
• You’re planning a pregnancy or are already pregnant
• You suffer from a disorder that can affect your nutrient absorption (e.g., celiac disease, Crohn’s disease)
• You’re over age 50
• You have had previous nutrient deficiencies
• Your weight has changed unexpectantly
• Or you just want to improve your overall health!

How can I check my nutrition levels from home?
Previously, a doctor’s visit or laboratory appointment was required to collect a blood sample for nutritional testing. However, that is no longer the case, as we offer at-home test kits to make the whole process a lot simpler.

Simply order the test you require (see our comprehensive list here) and a test kit will be shipped out to you. The test kit contains all the samples and instructions that you need to collect your own blood sample. And don’t worry, only a tiny amount of blood is required and it is simply collected from a relatively painless finger-prick. No needles required!

After collecting your sample, return it to our laboratory for very accurate and fully automated laboratory analyses. As soon as testing is complete, your results are available through our secure online portal. We recommend discussing any abnormal results with your healthcare provider to determine what steps you should take to improve your nutritional health.

What vitamin and mineral tests are available through Genetrack Diagnostics?
We offer tests for several of the most common deficiencies:

• Vitamin D
• Vitamin B12
• Folate (vitamin B9)
• Iron (see note below*)

*We offer different analyses for a thorough understanding of your iron status: Iron, Ferritin, Transferrin, and TIBC.

Should I take a combination test?
A deficiency in one vitamin or mineral can increase the risk of other deficiencies; hence a combination test is often a wise choice. We offer the following combination tests:

• Vitamin B12 and Folate
• Vitamin B12, Folate, and Vitamin D
• Iron, Ferritin, Transferrin, TIBC
• Nutritional Deficiency Panel (Vitamin B12, Folate, Vitamin D, Ferritin)

For more information about the vitamins and minerals that we offer laboratory tests for, see our other articles here.

References:
1. U.S. Centers for Disease Control and Prevention. Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population 2012. Atlanta (GA): National Center for Environmental Health; April 2012.

Vitamin D is commonly known as the “sunshine vitamin” because we are able to synthesize vitamin D when our skin is exposed to sunlight. Vitamin D is important for healthy bones and muscles, a good immune system, glucose metabolism, and cell growth. But there are more than just the physical benefits of vitamin D, as this important vitamin also plays a role in mental health and cognitive function (1).

This article focuses on the links between low vitamin D and depression. For more information about vitamin D, see our previous articles:

• Signs of vitamin D deficiency
• How can I boost my vitamin D levels?
• What can increase the risk of low vitamin D?

What is depression?
Depression is also known as major depressive disorder. It is a common medical illness that is estimated to affect 1 in 6 people at some point in their life (2). Symptoms can range from mild to severe and can include:

• Feelings of sadness
• Losing interest in activities that previously enjoyed
• Appetite changes along with weight changes
• Changes in sleeping patterns (increased sleep or difficulties sleeping)
• Lack of energy
• Fatigue
• More purposeless activity (e.g., pacing, handwringing)
• Slowed movements or speech
• Feelings of guilt or worthlessness
• Difficulty concentrating and making decisions
• Contemplating suicide

What evidence is there linking low vitamin D to depression?
Evidence has been shown in many studies that there is an association between low vitamin D and an increased risk of depression.

These studies have included large meta-analyses, such as a 2013 study of 31,424 participants, which showed lower vitamin D levels were found in people with depression compared to controls and an increased odds ratio of depression for the lowest versus highest vitamin D categories (3).

Another study published in 2014, analyzed 1892 participants in the Netherlands Study of Depression and Anxiety showed that low vitamin D levels were associated with the presence and severity of depressive disorder suggesting that low vitamin D may represent an underlying biological vulnerability for depression (4).

A 2017 review article examined multiple different studies to also reach the conclusion that there is an association between low vitamin D and depression. This article also discusses a link between vitamin D and Seasonal Affective Disorder (SAD), which is a depressive subtype characterized by symptoms that occur in the darkest time of the year (5).

A recent review article (January 2020) again found an inverse correlation between vitamin D levels and clinical depression (6). There have been a number of other studies that have also been published in recent years, each finding an association to some degree between low vitamin D and the risk of depression. However, whether this relationship is causal (i.e. low vitamin D causes depression) remains to be confirmed.

Are vitamin D supplements effective for treating depression?
Despite the increasing evidence supporting an association between low vitamin D and depression, there are conflicting results about whether or not vitamin D supplements are beneficial for reducing the risk and treating depression. This is likely because the actual relationship between vitamin D and depression has yet to be confirmed. It is likely that low vitamin D doesn’t actually cause depression, but maybe low vitamin D could be considered as a marker of depression, and other factors are also involved.

A recent clinical trial (published August 2020) investigated whether long-term supplementation with vitamin D₃ could prevent depression in the general adult population. The study followed 18,353 adults for five years to see if there was a difference in rates of depression in those receiving a vitamin D₃ supplement compared to those receiving a placebo. The results from this trial do not support the use of vitamin D₃ in adults to prevent depression (7).

Another study in 2013 showed that daily vitamin D₃ supplementation for 6 months did not provide a reduction in symptoms of depression (8).

However, a small November 2020 study found that a single parenteral administration of high-dose vitamin D was associated with significant improvements in depression over 12 weeks in individuals that had both major depression and vitamin D deficiency (9). This small study does have some limitations (e.g., small sample size and a single-center design); however, it does illustrate the there may be a vitamin D supplementation approach that is beneficial to treat depression.

How can I measure my vitamin D levels?
Checking your vitamin D levels is quick and simple. It just requires a simple finger prick blood sample with our Vitamin D Test. This test measures your blood concentration of 25-OH vitamin D, which is the main indicator of vitamin D status. This test can tell you if your levels are in the healthy optimal range, or if you have mild to moderate deficiency, or if you have a severe deficiency. It can also detect vitamin D levels that are too high (vitamin D toxicity), which can occur in people who take an excessive amount of vitamin D supplements.

References:
1. Jones G. (2014). Vitamin D. In A. C. Ross, et al., Modern Nutrition in Health and Disease (11th ed). Philadelphia: Lippincott Williams & Wilkins.
2. What is Depression? American Psychiatric Association.
3. Anglin RES, et al. (2013) Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. British J Psychiatry, 202(2): 100-107.
4. Milaneschi Y, et al. (2014). The association between low vitamin D and depressive disorders. Mol Psychiatry 19: 444–451.
5. Parker GB, et al. (2017). Vitamin D and depression. J Affect Disord. 208: 56-61.
6. Menon V, et al. (2020). Vitamin D and depression: A critical appraisal of the evidence and future directions. Indian J Psychol Med. 42(1): 11-21.
7. Okereke OI, et al. (2020). Effect of long-term vitamin D₃ supplementation vs placebo on risk of depression or clinically relevant depressive symptoms and on change in mood scores. A randomized clinical trial. JAMA. 324(5): 471-480.
8. Hansen JP, et al. (2019). Vitamin D3 supplementation and treatment outcomes in patients with depression (D3-vit-dep). BMC Res Notes12(203).
9. Vellekkatt F, et al. (2020). Effect of adjunctive single dose parenteral Vitamin D supplementation in major depressive disorder with concurrent vitamin D deficiency: A double-blind randomized placebo-controlled trial. J Psychiatr Res. 129: 250-256.

Folate is a very important nutrient that is absolutely essential for a healthy normally functioning body. It’s needed for the formation of DNA and RNA, the formation of neurotransmitters, the metabolism of amino acids, and the proper formation of the nervous system (1). See our previous post “The importance of folate” for more information about folate.

Folate, also known as vitamin B9 is even more important during pregnancy to ensure the health of the unborn baby.

Folate is naturally present in many foods, but there is also a synthetic form, called folic acid, that is added to many enriched foods, as well as available as a dietary supplement.

How do you know if you are getting enough folate?
Folate requirements differ by age and pregnancy and breastfeeding status. Normally adults require 400 mcg DFE per day, with increasing amounts required during pregnancy (600 mcg) and while breastfeeding (500 mcg).

DFE stands for dietary folate equivalent. This term is used because synthetic folic acid has a much higher bioavailability than dietary folate (85% versus 50%). Basically, this means that the body is able to use a lot more folic acid compared to folate (2).

The easiest way to check your folate levels is with our Folate Test from a simple self-collected finger-prick blood sample.

Foods to eat to obtain more natural folate

• Beef liver: A single 3 oz serving can provide 54% of the recommended daily value (DV) for an adult.
• Spinach: An excellent source of folate with one serving providing 33% of an adult’s DV.
• Asparagus and brussels sprouts: Both provide 20-22% of an adult’s DV from one serving.
• Lettuce, avocado, broccoli, mustard greens, and green peas: All provide 12-16% of an adult’s DV from one serving.
• Kidney beans and wheat germ: One serving provides 10-12% of an adult’s DV.

Enriched foods to eat to obtain more folic acid
These foods have had the synthetic form (folic acid) added to them, so they are another very beneficial source of this essential nutrient:

• Rice and pasta: Generally, a single serving contains 19-22% of an adult’s DV.
• Breakfast cereals: Many ready-to-eat breakfast cereals have been enriched with 25% of an adult’s DV in a single serving.
• Bread: Enriched bread provides 13% of an adult’s DV from a single slice.

These folate and folic acid food contents were obtained from Folate, Fact Sheet for Health Professionals (1). The foods shown here are by no means an exclusive list, as there are many other foods that also naturally contain folate.

Dietary supplements
Folic acid is available as folic acid alone, as well as part of many multivitamins and prenatal vitamins. Usually, these supplements contain 680–1360 mcg DFE for adults, with 340–680 mcg DFE for children’s vitamins. When these supplements are taken with food, about 85% of the folic acid is able to be absorbed and utilized by the body. However, if consumed without food, nearly 100% of the folic acid can be absorbed (1).

References:
1. Folate: Fact Sheet for Health Professionals. (2020, June 3). NIH
2. Bailey LB, & Caudill MA. (2012). Folate. In J. W. Erdman, I. A. Macdonald, & S. H. Zeisel, Present Knowledge in Nutrition. Washington, DC: Wiley-Blackwell. 321-342.

Vitamin D is commonly known as the “sunshine vitamin”. It has this nickname because when our skin is exposed to sunlight, our body is able to synthesize Vitamin D. Vitamin D is important for healthy bones and muscle, a good immune system, glucose metabolism, and cell growth. But in many populations around the world, vitamin D deficiency is common.

In this article, we will discuss the various things that can contribute to an increased risk of vitamin D deficiency, along with the common symptoms that occur in vitamin D deficiency, and ways to improve low vitamin D levels.

What populations have an increased risk of vitamin D deficiency?

• Breastfed infants: Human milk alone does not usually provide enough vitamin D to meet adequate intake levels. In addition, the American Academy of Pediatrics (AAP) advises parents to keep infants under 6 months old out of direct sunlight (1), so vitamin D through UV exposure does not usually occur in infants.
• Older adults: Vitamin D synthesis in the skin reduces with age and older adults are more likely to spend more time indoors (2).
• People with limited sun exposure: For example, those that wear head coverings for religious purposes or have occupations that limit sun exposure (3).
• People with darker skin: Increased skin melanin (which is what makes skin darker) reduces vitamin D synthesis because the increased melanin absorbs more of the sun rays before vitamin D synthesis is triggered (3).
• People who have conditions that limit fat absorption: For example, celiac disease and Crohn’s disease. These conditions reduce the absorption of vitamin D in the gut, as it is a fat-soluble vitamin.
• Obese people: Obesity is associated with an increased risk of deficiency, as the increased subcutaneous fat in obese individuals sequesters more of the vitamin D synthesized from sun exposure, so there is less available throughout the rest of the body (4).
• Stomach surgery: Unfortunately, the type of surgery that can be used to help with weight loss can also contribute to an increased risk of vitamin D deficiency, as it can affect the ability to absorb vitamin D and other vitamins and minerals from food (5).
• People with kidney disease: The kidneys convert vitamin D from supplements and the sun into an active form that can be used by the body. Chronic kidney disease inhibits this conversion (6).
• People taking certain medications: Some drugs can inhibit the body’s natural ability to convert vitamin D into its active form. These include antiepileptics, anti-inflammatories, antibiotics, some herbal remedies (e.g., St John’s wort), steroids, drugs used to treat some breast cancers, and cholesterol-lowering drugs (7).

What are the common symptoms of vitamin D deficiency?
Vitamin D deficiency can cause a range of symptoms (2), including:

• Fatigue
• Bone pain
• Muscle weakness, aches, and cramping
• Mood changes, e.g., depression

Long-term vitamin D deficiency can lead to rickets in children and osteomalacia in adults, which are both characterized by soft and weak bones (2). Vitamin D deficiency also increases the risk of various other health complications, including diabetes, obesity, high blood pressure, cardiovascular disease, inflammatory diseases, asthma in children, and specific cancers (1).

How can I boost my vitamin D levels?
Many people who only have a mild vitamin D deficiency do not show any noticeable symptoms, and it is always better to diagnose and treat a health problem BEFORE it gets worse.

Checking your vitamin D levels is quick and simple. It just requires a simple finger prick blood sample with our Vitamin D Test. This test measures your blood concentration of 25-OH vitamin D, which is the main indicator of vitamin D status. This test can tell you if your levels are in the healthy optimal range, or if you have mild to moderate deficiency, or if you have a severe deficiency. It can also detect vitamin D levels that are too high (vitamin D toxicity), which can occur in people who take an excessive amount of vitamin D supplements.

Ways to increase your vitamin D levels include:

• Increase consumption of foods that naturally contain vitamin D, such as fish liver oils and fatty fish (e.g., cod liver oil, trout, and salmon)
• Ensure that you are choosing common foods that have been fortified with vitamin D (had vitamin D added to them). These include most dairy milk and plant milk options, and ready-to-eat breakfast cereals.
• Take dietary supplements that contain vitamin D, but be careful not to overdose on vitamin D.

References:
1. Davis CD, & Dwyer JT. (2007). The ‘sunshine vitamin’: benefits beyond bone? J Natl Cancer Inst. 99, 1563-1565.
2. Dietary Reference Intakes for Calcium and Vitamin D. (2010). Washington, DC, USA: National Academy Press.
3. Vitamin D: Fact Sheet for Health Professionals (2020, October 9). NIH
4. Jones G. (2014). Vitamin D. In Ross AC, et al. Modern Nutrition in Health and Disease (11th ed). Philadelphia: Lippincott Williams & Wilkins.
5. Johnson JM, et al. (2006) The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg. 243(5): 701-705.
6. Vitamin D: The Kidney Vitamin? National Kidney Foundation. August 2014.
7. Gröber U & Kisters K. (2012) Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol. 4(2): 158-166.

Anemia is a term that many people are familiar with. It can cause fatigue, weakness, and pale skin. But often people don’t realize that iron deficiency is not the only cause of anemia. A deficiency in certain B vitamins (especially folate and B12) can also lead to a type of anemia, called megaloblastic anemia.

Megaloblastic anemia is characterized by the production of abnormally large immature red blood cells in the bone marrow, which results in low numbers of healthy fully-matured red blood cells in circulation (1).

In this article, we will discuss the symptoms, including anemia, that are associated with vitamin B deficiency.

What are B vitamins?
B vitamins are a class of water-soluble compounds that play important roles in health and wellness, particularly cell metabolism and synthesis of red blood cells. There are eight different B vitamins: B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folate), and B12 (cobalamin) (2).

What are the best sources of B vitamins?
The best sources of B vitamins are meat, eggs, fish, and dairy products, as well as leafy green vegetables and legumes for many B vitamins (with the notable exception of vitamin B12, which is generally not present in plant foods).

What are the roles of B vitamins? And what happens during deficiency?
B vitamins are essential for the functions of numerous enzymes throughout the body (2). Here is a quick overview of what each of the B vitamins does, and the symptoms that can occur when people are deficient in these important vitamins:

• B1 (thiamin) is important for the growth and function of various cells. Symptoms of deficiency can include weight loss, confusion, muscle weakness, reduced immune function, and peripheral neuropathy (reduced feeling in hands and feet) (3).
• B2 (riboflavin) is essential for cell growth, energy production, and the breakdown of fats, steroids, and medications. Symptoms of deficiency can include swelling and pain in the tongue, mouth, and throat, hair loss, anemia, and eye problems (4).
• B3 (niacin) helps for the generation of energy, cholesterol, and fats, and the creation and repair of DNA. Deficiency can cause depression, headache, fatigue, hallucinations, a scaly skin rash, and constipation or diarrhea (5).
• B5 (pantothenic acid) helps break down fatty acids and build fats. Deficiency symptoms can include headaches, fatigue, sleep issues, muscle cramps, nausea, and numbness or burn in the hands or feet (6).
• B6 (pyridoxine) is important for the proper breakdown of proteins, carbs, and fats, maintenance of homocysteine levels, immune function, and brain health. Deficiency is usually in conjunction with a deficiency in another B vitamin (e.g., B9 or B12) and can cause anemia, skin conditions, depression, reduced immunity, and confusion (7).
• B7 (biotin) is another B vitamin important for breaking down fats, carbs, and proteins from food. Deficiency symptoms can include thin hair, skin rashes, and brittle nails (8).
• B9 (folate) is the natural form of this vitamin, while folic acid is the synthetic form that is added to foods and available as a supplement. It is essential for the formation of nucleic acids, protein metabolism, and the generation of red blood cells. Deficiency can cause megaloblastic anemia, which is characterized by weakness, fatigue, irregular heartbeat, shortness of breath, hair loss, pale skin, and mouth sores (9).
• B12 (cobalamin) is also essential for red blood cell production and the formation of DNA, as well as the function and development of brain and nerve cells. B12 deficiency is the most common B vitamin deficiency and can cause megaloblastic anemia (with the same symptoms as described for B9), as well as nerve damage leading to numbness in the hands and legs, depression, and seizures in extreme cases (10).

What factors can increase the risk of deficiency?
Each of the B vitamins deficiency can have different factors that contribute to an increased risk, but the primary reasons are a non-balanced diet, malnutrition, excess alcohol consumption, drug and medication use, and health complications that affect absorption (e.g., Celiac disease). Other factors that can also influence the risk include thyroid issues (for B2), carcinoid syndrome (for B3), genetic variants (e.g., MTHFR variants can affect folate levels), pregnancy (particularly for folate), vegan diets (particular for B12 as it is only naturally found in foods from animal sources).

How can I determine if I have a deficiency?
A simple blood test is all that is required to diagnose a deficiency. We offer lab tests for the most common B vitamin deficiencies–folate and B12. These tests just require a simple self-collected finger-prick blood sample and results are available online as soon as testing is complete. We recommend discussing any abnormal results with your healthcare provider to determine the next steps to improve your health.

References:
1. Anemia, Megaloblastic. Rare Disease Database, National Organization of Rare Disorders.
2. B Vitamins. The Nutrition Source, Harvard School of Public Health.
3. Thiamin – Vitamin B1. The Nutrition Source, Harvard School of Public Health.
4. Riboflavin – Vitamin B2. The Nutrition Source, Harvard School of Public Health.
5. Niacin – Vitamin B3. The Nutrition Source, Harvard School of Public Health.
6. Pantothenic Acid – Vitamin B5. The Nutrition Source, Harvard School of Public Health.
7. Vitamin B6. The Nutrition Source, Harvard School of Public Health.
8. Biotin – Vitamin B7. The Nutrition Source, Harvard School of Public Health.
9. Folate (Folic Acid) ­– Vitamin B9. The Nutrition Source, Harvard School of Public Health.
10. Vitamin B12. The Nutrition Source, Harvard School of Public Health.

Vitamin D is commonly known as the “sunshine vitamin”. It has this nickname because when our skin is exposed to sunlight, our body is able to synthesize Vitamin D. Vitamin D is important for healthy bones and muscle, a good immune system, glucose metabolism, and cell growth. But in many populations around the world, vitamin D deficiency is common.

How do I know if I have vitamin D deficiency?
There are various symptoms associated with vitamin D deficiency, including bone pain, frequent illnesses, and muscle weakness. However, many people who only have a mild deficiency, do not show any noticeable symptoms, and it is always better to diagnose and treat a health problem BEFORE it gets worse.

Checking your vitamin D levels is quick and simple. It just requires a simple finger prick blood sample with our Vitamin D Test. This test measures your blood concentration of 25-OH vitamin D, which is the main indicator of vitamin D status. This test can tell you if your levels are in the healthy optimal range, or if you have mild to moderate deficiency, or if you have a severe deficiency. It can also detect vitamin D levels that are too high (vitamin D toxicity), which can occur in people who take an excessive amount of vitamin D supplements.

Is sunshine the only way to obtain vitamin D?
No, although vitamin D is the “sunshine vitamin”, it is also naturally present in some food sources, is added to several fortified foods, and is available as a supplement too.

What foods should I eat to increase my vitamin D levels?
There are only a few foods that naturally contain vitamin D. The best sources are fish liver oils and fatty fish, such as trout and salmon. For example, just one tablespoon of cod liver oil provides 170% of the recommended daily intake for adults, while 3 ounces of salmon provides 71% (1).

Some mushrooms are available that have been treated with UV light to increase their vitamin D levels with ½ cup providing 46% of the recommended daily intake, but it is important to realize that untreated mushrooms contain significantly less vitamin D. Other foods that naturally contain small amounts of vitamin D include eggs, beef, chicken, and cheese, but the levels of vitamin D from these sources can vary depending on the animals’ diet (1).

There are also several foods available that have had vitamin D added to them, and these fortified foods provide most of the vitamin D in American diets. All dairy milk in Canada must be fortified with vitamin D, and most dairy milk in the U.S. is also fortified. Plant milk options (e.g., soy milk) are usually fortified too. Many ready-to-eat breakfast cereals have added vitamin D, and all infant formula in the U.S. and Canada must contain vitamin D. Other foods that are also commonly fortified include some brands of orange juice, yogurt, and margarine (1).

Should I increase my sun exposure to get more vitamin D?
Although most people around the world get at least some of their vitamin D from sun exposure, it is difficult to determine how much sun is needed to maintain adequate vitamin D levels. Some vitamin D researchers suggest 5-30 minutes of sun exposure at least twice a week on the face, arms, hands, and legs without sunscreen. However, it is very important to limit exposure to UV radiation, as it is the leading cause of skin cancer (1).

Are there other ways to increase my vitamin D levels?
Many different dietary supplements are available that include vitamin D, and this is the recommended way to increase vitamin D levels if dietary changes are inadequate. However, it is important not to overdose on vitamin D supplements, as vitamin D toxicity can occur, causing nausea, vomiting, excessive thirst, kidney stones, and severe pain (1).

References:
1. Vitamin D Fact Sheet for Health Professionals. NIH, Office of Dietary Supplements. Updated August 2021.

You may have heard about iron deficiency anemia, but did you know that too much iron is also a health risk?

Excess iron intake from dietary sources is very unlikely in adults with normal intestinal function, as usually only 8–10% of iron from the diet is absorbed. However, there are specific situations where iron overload can occur, including by intaking too much iron in supplements or medicines or in people affected by hemochromatosis.

What is hemochromatosis?
Hemochromatosis is an inherited disorder where the body absorbs three to four times more iron than normal (1). This excess iron cannot be naturally excreted from the body, so it accumulates in organs and tissues, eventually causing serious health complications. The symptoms of hemochromatosis include fatigue, joint pain, abdominal pain, memory problems, depression, decreased sex drive, shortness of breath, and heart flutters. Further serious complications can occur in untreated individuals, including heart failure, liver cirrhosis and disease, and endocrine problems (2).

How common is hemochromatosis?
About 1 in 10 whites carry the most common genetic mutation that causes hemochromatosis. However, two copies of the mutation are usually required for extra iron absorption to occur, and only about 4.4 whites per 1000 carry two copies and have hemochromatosis (3).

Is hemochromatosis treatable?
Thankfully hemochromatosis is easily treated by blood removal (phlebotomy), which also removes the excess iron. Hemochromatosis patients should also limit their dietary iron intake and avoid iron and vitamin C supplements, as vitamin C increases the absorbance of iron (3).

Unfortunately, many people with hemochromatosis are unaware of their diagnosis until symptoms occur, and by then the excess iron may have already caused tissue and organ damage that is not repaired by phlebotomy.

What are the symptoms associated with excess iron from supplements?
Gastrointestinal upsets are common from acute intakes of more than 20 mg/kg iron. Symptoms can include constipation, nausea, abdominal pain, and vomiting. If a very high dose is ingested, serious complications can occur, such as multisystem organ failure, coma, convulsions, or death (3).

How can I get my iron levels checked?
We offer several tests that can determine your iron status. All of these tests just require a simple finger prick blood sample for an accurate analysis.

• The iron test measures the levels of iron circulating in the blood. Serum iron levels above 150 ug/dL occur in hemochromatosis patients.
• Ferritin is a protein that helps store iron. The ferritin test measures how much of the iron stores have been used. Ferritin levels above 300 ng/mL in males or 200 mg/mL in females are indicative of hemochromatosis (4).
• Transferrin is the main protein that binds and transports iron around the body. The transferrin test measures your levels of transferrin, while the transferrin saturation test calculates the percentage of transferrin that is bound to iron. Transferrin saturation levels above 45–50% indicate iron overload (4).

These tests are available as individual tests as well as a cost-saving combination test.

References:
1. Witte DL, et al. (1996). Hereditary hemochromatosis. Clinica Chimica Acta. 245(2), 139-200.
2. Beutler E, Felitti V, Gelbart T, Ho N. (2001) Genetics of Iron Storage and Hemochromatosis. Drug Metab Dispos. 29(4):495-499.
3. Iron, Fact Sheet for Health Professionals. NIH. Updated March 2021.
4. Crownover BK, Covey CJ. (2013) Hereditary Hemochromatosis. Am Fam Physician. 87(3):183-190.

Low iron is quite common, particularly among women of reproductive age and people who follow a low-iron diet. When iron levels decrease, it can result in iron deficiency anemia, which is characterized by fatigue, weakness, pale skin, and headaches (1).

Why is iron so important?
Iron is an essential mineral with numerous important functions in the body. It is a component of hemoglobin and myoglobin, two proteins that carry oxygen–hemoglobin in red blood cells and myoglobin in muscle cells. Iron is also important for physical growth, neurological development, cell functions, and the production of some hormones (2).

What are the signs of iron deficiency?
Usually, iron deficiency develops slowly as it may take a few months for the body’s iron stores to be depleted. Often mild iron deficiency doesn’t cause any symptoms, but if the iron levels continue to fall, other signs and symptoms can occur (3). These include:

• Brittle nails
• Pale skin
• Tongue swelling or pain
• Chest pain
• Difficulty concentrating and dizziness
• Fatigue and weakness
• Headache
• Irregular heartbeat
• Shortness of breath
• Pica (unusual craving for non-food items, e.g., ice, clay

Can iron deficiency cause further complications?
Yes, if severe iron deficiency is not treated, it can lead to serious complications, including:

• Depression
• Heart problems (e.g., arrhythmias, enlarged heart)
• Increased susceptibility to infections
• Development delays in children
• Pregnancy complications (e.g., preterm delivery, low birth weight)

Who is most at risk of iron deficiency?
In developed countries, the populations most at risk for iron deficiency are:

• Pregnant women: red blood cell production increases a lot during pregnancy, so lots more iron is required. Iron deficiency during pregnancy increases the risk of premature birth and low birth weight.
• Infants and young children are growing so quickly so have high iron requirements. Infants that are born prematurely or with low birth weight or to iron-deficient mothers are the most at-risk.
• Women with heavy menstrual bleeding lose more blood each month, and with that blood, they lost more iron.
• Frequent blood donors due to the iron lost with each blood donation.
• Cancer patients, particularly those with chronic blood loss (e.g., colon cancer)
• People with gastrointestinal issues (e.g., celiac disease) or have had gastrointestinal surgery may have reduced absorption of iron from food, or have to follow dietary restrictions that affect iron absorption
• People with heart failure, which may be caused by poor nutrition or absorption, or the use of oral anticoagulants may contribute to increased blood loss.
• Vegetarians and vegans may be at increased risk, as they consume less heme iron, which is found in animal sources and is more easily absorbed than non-heme iron from plant sources.

How can I get my iron levels checked?
We offer several tests that can determine your iron status. All of these tests just require a simple finger prick blood sample for an accurate analysis.

• The iron test measures the levels of iron circulating in the blood. In some instances, people with low iron levels may actually have normal iron levels circulating in the blood but still have low iron stores.
• Ferritin is a protein that helps store iron. The ferritin test measures how much of the iron stores have been used. Low ferritin levels (below 10 mg/dL) are indicative of iron deficiency.
• Transferrin is the main protein that binds and transports iron around the body. The transferrin test measures your levels of transferrin, while the transferrin saturation test calculates the percentage of transferrin that is bound to iron. Transferrin saturation levels below 20% indicate iron deficiency.

These tests are available as individual tests as well as a cost-saving combination test.

References:
1. Iron-Deficiency Anemia. American Society of Hematology.
2. Iron, Fact Sheet for Health Professionals. NIH. Updated March 2021.
3. Iron-Deficiency Anemia. National Heart, Lung, and Blood Institute. NIH.