Resident Medical Authority: J. E. Williams, OMD, FAAIM PART I Blood Testing for Vegetarians & Vegans Personally, I started my own personal experiment with vegetarianism and vegan lifestyle in 1972, and I also conceived and raised children as vegetarians (until they were pre-teen). I have 30 years of clinical experience in natural medicine, and for 25 years, I was a busy clinician in Southern California. Thus, I have earned my credentials and have seen it all. I know through all of this that if you want to get your cholesterol and LDL (bad cholesterol) down to bare bones levels, go vegan. If you want to boost your folic acid and antioxidant levels to new heights, eat more plants. It is the same with reducing your risk for a heart attack to zero, and preventing many types of cancer. But, if you want to have strong vitamin B12 levels, and enough iron and albumin, vegetarians and vegans are vulnerable. This blog is the first in a series where I discuss the basic laboratory tests most important for plant-based diets. Lets look at the 10 most helpful ones for evaluating deficiencies and the consequences of not having adequate levels of certain nutrients. 1. CBC Complete Blood Count with Differential and Platelets: This group of tests tells if you are anemic, immune deficient, or have an infection or allergies. Low RBC (red blood count), hemoglobin, and hematocrit are signs of anemia. The CBC helps determine your general health status. If have fatigue or weakness, or suspect an infection, this test can help determine what is the cause. 2. CMP Comprehensive Metabolic Panel: The CMP is a group of 14 tests that provides information about the status of your kidneys, liver, and electrolyte and acid/base balance, as well as of your blood sugar (glucose) and blood proteins (total protein, albumin, and globulin). Abnormal results, especially combinations of abnormal results, indicate a problem that needs to be addressed. Total protein below 6.5 and albumin below 3.9 are signs of protein deficiency. Glucose (blood sugar) is also tested in this panel. It is uncommon for plant-based eaters to be diabetic. Some times, however, glucose can be too low, suggesting hypoglycemia. 3. Ferritin: This test helps assess iron stores in the body. It is useful in combination with an iron and TIBC to evaluate the severity of iron deficiency or overload.

4. Folic Acid: This test gives an idea of your level of folate. It is rarely low in plant-based diets. However, higher than normal levels, common in vegetarians and vegans, combined with low vitamin B12 levels, magnifies vitamin B deficiency in the body. The amount of folate inside the red blood cell (folate, RBC) may also be measured and is normally higher inside the cell than in the serum. 5. Homocysteine: An elevated homocysteine level helps determine B12 or folate deficiency. Elevated levels of homocysteine (above 10 micromoles/liter) are associated with atherosclerosis (hardening and narrowing of the arteries) and suggest an increased risk of heart attacks, strokes, blood clot formation, and Alzheimers disease. I want my patients to be lower than 9 micromoles/liter and optimally less than 6 micromoles/liter. 6. Iron total and TIBC (total iron binding capacity): Vegetarians can have adequate iron levels if they eat quantities of iron-containing vegetables and fruits, like spinach and raisins. However, raw vegans often show low levels of red blood cells and iron deficiency in their tests. Early iron deficiency causes no physical effects, so you may not know you levels are going down; but, as hemoglobin levels drop below 10 g per deciliter, things can get challenging. As the iron-deficiency progresses, symptoms begin to develop, including fatigue and tiredness, weakness, dizziness, and headaches. As iron reserves continue to be depleted, you can experience shortness of breath, ringing in the ears (tinnitus), drowsiness, and irritability. 7. Lipid Profile: This group of tests measures your blood fats (total cholesterol, LDL, HDL, and triglycerides) to determine risk for coronary heart disease. Vegetarians typical have normal lipid profiles, but vegans may have cholesterol levels that are too low (less than 135 mg/dL). Cholesterol is essential for life. A waxy substance manufactured from raw materials supplied in the diet, it is used to produce hormones and cell membranes and is transported in the blood. Cholesterol is the primary building block for steroid hormones like estrogen and testosterone, and adequate levels are required for health. 8. MMA Methylmalonic Acid, serum: MMA, along with homocysteine, help diagnose an early or mild B12 deficiency. If MMA and homocysteine levels are increased, then vitamin B12 deficiency may be present, indicating less available B12 at the tissue level. If only homocysteine is elevated, then folic acid may be low or not being metabolism properly. If

MMA and homocysteine levels are normal, it is unlikely that there is a B12 deficiency. 9. Vitamin B12: Both B12 and folate are necessary for normal red blood cell formation, tissue and cellular repair, DNA synthesis, and for nerve health. A deficiency in either B12 or folate causes macrocytic anemia. Also called megaloblastic anemia, this type of anemia is characterized by the production of fewer but larger red blood cells called macrocytes, leading to fatigue, weakness, and all the other symptoms of anemia. If your levels are below 400 pg/mL, suspect B12 deficiency. I like my patients to be at least 600-900 pg/mL. 10. Vitamin D, 25-Hydroxy: This test determines vitamin D3 status. It tells if you are susceptible to bone weakness, bone malformation, or abnormal metabolism of calcium. Since vitamin D is a fat-soluble vitamin and absorbed from the intestine like dietary fat, low-fat diets are prone to vitamin D deficiency. Also, people with conditions that interfere with fat absorption, such as cystic fibrosis and Crohns disease, irritable bowel syndrome, and Celiac disease are not able to absorb enough Vitamin D. Dr. Williams Suggested Panels for Vegetarians/Vegans

Complete Blood Count with Differential and Platelets Comprehensive Chemistry/Metabolic Panel Ferritin Folic Acid Homocysteine Iron, total and IBC Lipid Panel Methylmalonic Acid, Serum Vitamin B12 Vitamin D3, 25 Hydroxy

For more information on lab testing:

How To Read Your Blood Tests Lab Tests Online NIH Site WebMD