• Determining a vitamin deficiency: The diagnosis

    Posted on June 10, 2022 by in Ailments

    vitamin deficiency

    Vitamin deficiencies are also common in industrialized countries. Based on the symptoms alone, it is rarely possible to say specifically which vitamin is currently missing. 

    How to identify a vitamin deficiency

    A lack of vital substances is more widespread than you think – not only in third world countries but also in industrialized nations. The term “vital substances” includes all micronutrients, e.g. vitamins, minerals, trace elements and also numerous secondary plant substances with e.g. antioxidant or anti-inflammatory effects (e.g. carotenoids and flavonoids). This article is exclusively about the vitamins and the diagnosis of a vitamin deficiency.

    Of course, numerous preventive medical check-ups are offered nowadays, which should actually be better called early detection appointments, since it is usually only checked whether a certain disease is already there. As a precautionary measure, little is done with these campaigns.

    In any case, checking your personal supply of vital substances is not part of the preventive measures. Even when asked, not all doctors are willing to initiate the appropriate examinations. It is often discouraged since “there is no vitamin deficiency in industrialized countries and the corresponding tests are therefore completely superfluous”. Don’t worry, we explain what you need to look out for if you want to detect a vitamin deficiency.

    Health insurance companies rarely cover the costs

    Of course, the health insurance companies only cover the costs if certain symptoms already indicate a relevant deficiency, if there is a suspicion of a vitamin deficiency-related illness or if there are illnesses in the course of which vital substance deficiencies also occur (eg osteoporosis, diabetes, chronic inflammatory diseases, intestinal diseases or similar).

    Perhaps a vitamin B12 test would still be carried out with a vegan diet, but certainly not an all-around analysis. If you – as a symptom-free person – want to have certain vitamin or trace element values ​​​​determined as a purely preventive measure, or possibly want to know your omega-3 value, your heavy metal load or the state of your hormone balance, then you usually have to pay for these tests yourself

    vitamin deficiency

    A lack of vital substances can have many symptoms

    Optimizing the supply of vital substances is, therefore, an important preventive measure. However, if illnesses are already present or “only” unspecific symptoms are plaguing you (e.g. lack of concentration, tiredness, sleep disorders, hair loss, skin rash, etc.), then it makes all the more sense to determine the vital substance status. On the one hand, non-specific symptoms can indicate a lack of vital substances and, on the other hand, an all-around good supply of vital substances increases the chance of healing or improvement of the symptoms.

    Determining a vitamin deficiency: The diagnosis

    Regardless of the reason why you want a diagnosis of a possible vitamin deficiency, remember that your doctor does not always know how to determine your vital substance levels (in the serum, in the whole blood, in the urine?). It is therefore often helpful to know a little bit about it yourself or to consult a doctor/alternative practitioner who has expertise in the field of orthomolecular medicine (therapy with vital substances).

    We do not give guidelines or standard values ​​below, as these often vary depending on the laboratory and measurement method, and there are often different units in which values ​​are given.

    We indicate the average requirement values ​​for adults. They do not, therefore, apply to children, adolescents, pregnant or breastfeeding women. These are the official requirement values. They can also be higher and also vary from person to person. If vital substances are used therapeutically, significantly higher amounts are often required, but this should be discussed with the doctor or naturopath.

    Vitamin B12 (cobalamins)

    When it comes to vitamin B12, some doctors still like to determine the vitamin B12 in the serum directly. However, this value can still be in order if a defect has long existed. Therefore, to determine the vitamin B12 level, the so-called holoTC value in the serum is determined and, if the holoTC values ​​are not clear, the methylmalonic acid value in the urine is also determined.

    You can now also determine the vitamin B12 level with home tests. There is both the HoloTC measurement in the blood and the MMA measurement in the urine. However, the values ​​in the urine can in turn be falsified by other factors (e.g. an intestinal flora disorder), so that the HoloTC value in the blood is still the best.
    Stop taking vitamin B12 supplements 7 to 10 days before the measurement to prevent the values ​​from being falsified.

    The daily requirement of vitamin B12 is 3 µg. However, absorption is significantly better at 500 to 1000 µg, so mono-supplements with this vitamin are usually available in these dosages.

    Vitamin B1 (thiamine)

    Vitamin B1 is a nerve vitamin. If there is a corresponding deficiency, this could show up in neurological disorders, e.g. tingling in the arms and legs, nerve inflammation, hypersensitivity, etc. Tiredness, concentration problems, depression, anxiety, insomnia and dizziness could also indicate the need to take B1. Shortness of breath, tachycardia and paralysis can only occur in the event of a really severe deficiency, which is no longer to be observed in industrialized countries.

    Orthomolecular physicians recommend checking the vitamin B1 value in any case of neurological diseases, diabetes and high alcohol consumption.

    The value is best determined in whole blood, since around 90 percent of the vitamin B1 in the blood is in the blood cells, only 10 percent in the blood plasma. Vitamin B1 is also found in the blood cells mainly in the active form, while in the blood plasma it is still in the free, inactive form.

    Alcohol consumption can lead to a massive vitamin B1 deficiency. On the one hand, alcohol inhibits the absorption of vitamin B1 from the intestine into the blood and, on the other hand, it blocks the activation of the vitamin.

    Vitamin B1 is also sensitive to heat, which is why its content in food drops by up to 70 percent when it is boiled or fried. The requirement for vitamin B1 is given as 1 – 1.3 mg per day.

    Vitamin B2 (Riboflavin)

    Vitamin B2 is an energy and eye vitamin. It is therefore very important for energy production in the cell and for eye health. It is also very important for the skin and mucous membranes. The first deficiencies are therefore particularly evident in inflammation of the mucous membranes (e.g. in the intestines, stomach, but also in the mouth or nose) and dry or scaly skin.

    Vitamin B2 is yellow, which is why vitamin B complex preparations are usually also yellow and, in addition, when taking vitamin B preparations, the urine turns yellow, which is completely harmless. Vitamin B2 can be determined in serum or in whole blood. The requirement is 1.2 – 1.5 mg per day.

    Vitamin B3 (Niacin)

    Vitamin B3 is required for numerous metabolic processes and is involved in the regulation of cholesterol and blood fat levels, among other things. A deficiency is also reflected here in skin and mucous membrane disorders (scaly skin, gastrointestinal inflammation). Numbness in hands and feet can also occur. Changes in the psyche can also be observed in vitamin B3 deficiency.

    Vitamin B3 can be correspondingly helpful for psychological complaints (depression, ADHD symptoms, etc.) and high cholesterol levels. However, it has to be taken in high doses. Vitamin B3 doses of a few thousand milligrams can be used therapeutically, especially in the case of low HDL and high triglycerides or increased lipoprotein a (Lpa), which is difficult to influence with medication but is considered a strong risk factor for cardiovascular diseases. However, it must be started with low doses.

    Vitamin B3 also helps to reactivate vitamins C and E so that they can be used again after they have neutralized free radicals and been oxidized in the process.

    Vitamin B3 is not a true vitamin as it could be made from the amino acid tryptophan in an emergency. However, since a lot of tryptophan is required per milligram of vitamin B3 and food contains rather small amounts of tryptophan, it would be a shame to waste the amino acid for this purpose. Finally, tryptophan is also responsible for the formation of serotonin – our feel-good hormone – so that when tryptophan levels are low, mood can also drop.

    The vitamin B3 level can be determined in the serum. The requirement of this vitamin is 13 – 17 mg per day.

    Vitamin B5 (pantothenic acid)

    Like many B vitamins, vitamin B5 also has a healing effect on the skin and mucous membranes. It is therefore also often mixed in wound and healing ointments but administered internally also helps with inflamed mucous membranes of the digestive system, gastrointestinal ulcers or inflammatory problems in the mouth area.

    B5 (always together with the entire B complex) can also be integrated into holistic therapy for headaches and chronic fatigue. Vitamin B5 can be determined in the serum. The requirement is around 6 mg per day.

    Vitamin B6 (pyridoxine)

    Vitamin B6 is a typical co-enzyme. It accelerates the reactions of around 200 enzymes and is therefore extremely important – whether for the immune system, the nervous system, blood formation or for mental well-being and good sleep.

    According to orthomolecular doctors, many people have a deficiency here, not least because the pill can cause a B6 deficiency. This shows up in skin problems, neurological disorders (tingling, numbness), depression, poor sleep and anemia.

    If the homocysteine level is elevated, B6 is given together with B12 and folic acid to lower the high homocysteine level again. This is considered a risk factor for cardiovascular disease because homocysteine ​​- a waste product of protein metabolism – can contribute to oxidative stress and damage blood vessels. You take up to 300 mg of vitamin B6 under the supervision of a doctor, but start with low doses and increase them with regular monitoring of the homocysteine level until it is regulated.

    The vitamin has also proven to be helpful for vomiting during pregnancy. However, under no circumstances should you take more than 25 mg of vitamin B6.

    Vitamin B6 can be determined in serum, but the values ​​in whole blood are said to be more accurate. The requirement of the vitamin is 1.2 – 1.6 mg per day.

    Vitamin B7 (biotin)

    Biotin is particularly known as a hair vitamin, as it is often recommended for hair loss. Here, however, it only helps noticeably if the hair loss was also caused by a biotin deficiency.

    Since biotin has many other tasks in the body (energy generation, fatty acid synthesis, protein metabolism, etc.), care should always be taken to ensure an adequate supply. A possible involvement of a biotin deficiency is also discussed in the case of panic states and fears.

    Biotin can be measured in serum. The requirement is around 0.3 – 0.6 mg per day.

    Vitamin B9 (folic acid)

    In its natural form, folic acid is called folate. Since the term folic acid – although it only describes the synthetic form – is much more common, we will stick to this name here.

    Folic acid deficiency is common in most diets, since folic acid is particularly present in green leafy vegetables, legumes and vegetables and is sensitive to heat, so its content is reduced by up to 75 percent during cooking.

    Folic acid is particularly involved in cell division processes (growth, healing, regeneration) and in the formation of genetic material (DNA).

    A folic acid deficiency can manifest itself with hair loss, changes in the oral mucosa, depression, neurological disorders and digestive problems (e.g. diarrhoea).

    Folic acid is measured in serum. The need for folic acid is 300 to 400 µg per day. Before pregnancy and in early pregnancy, it is recommended to take 400 µg prophylactically – completely independent of the status, which in this case does not have to be checked in advance.

    If you want to take folic acid together with vitamins B6 and B12 to lower the homocysteine level or if there is a proven deficiency, significantly higher doses are required (1000 to 2000 µg). Doses of up to 5000 µg are sometimes taken to lower homocysteine ​​(if prescribed by the doctor).

    The vitamin B complex

    If you want to have every single B vitamin checked by a doctor, this can be expensive. However, it is almost impossible to overdose on B vitamins, so they can also be taken purely prophylactically without a prior diagnosis – especially if relevant symptoms are observed (skin problems, psychological complaints, neurological disorders (tingling, numbness, but also headaches, tiredness or similar)).

    Vitamin C (ascorbic acid)

    Vitamin C is a vitamin that should be consumed in adequate amounts every day. It is therefore not stored for a particularly long time. We would advise against measuring and instead recommend consuming enough vitamin C every day. It must be assumed that the officially specified requirement of 100 to 125 mg vitamin C per day is certainly too low. You would already cover this with two oranges or a bowl of strawberries plus a salad plate made of lettuce and red peppers.

    However, with a healthy diet rich in vital substances, you can easily double the amount of vitamin C per day. For example, with two oranges and one banana for breakfast (110 mg) and a large salad for lunch (100 mg). If you then eat a vegetable dish in the evening, you have around 250 mg of vitamin C.

    If you cannot manage this form of nutrition every day, then take a natural vitamin C supplement, e.g. Acerola powder, sea buckthorn juice or preparation from rose hips. This way you can also get 300 mg and more of vitamin C per day.

    Since the body can only absorb a certain amount of vitamin C at a time, it is of no use if, for example, you take a spoonful of acerola powder in the morning and nothing more for the rest of the day. So split your vitamin C dose into three or more doses. You don’t have to worry about excess. These are excreted in the urine.

    Vitamin D (cholecalciferol)

    The measurement of the vitamin D level, on the other hand, should be carried out regularly. Since there has been so much talk about vitamin D lately, many people ask their doctor for a test.

    If the result shows no defect, all the better. However, if there is a defect, you would never have found out about it without a test. A vitamin D deficiency, however, is now associated with probably every chronic disease, so everyone should know their vitamin D value and every doctor should take this aspect into account – especially if an illness is already present.

    Vitamin D is determined in the serum. The storage form of the vitamin, which is called 25-hydroxycholecalciferol (abbreviated to 25-OH-D3), is measured. This storage form is taken up by the cells as needed and only then converted into the actually effective hormone vitamin D3.

    Vitamin E (tocopherol)

    Vitamin E is an important antioxidant that protects cell structures as well as other endogenous structures such as hormones, fatty acids and enzymes from free radicals. It also has a “blood-thinning” effect, which means it works against the formation of blood clots that could block blood vessels.

    Vitamin E is also involved in the formation of antibodies and is therefore important for a functioning immune system. It is also said to have anti-cancer properties.

    According to official opinion, there should not be a shortage in industrialized nations. However, orthomolecular physicians point out latent deficiencies that can lead to cancer, rheumatism, diabetes, eye diseases and arteriosclerosis in the long term, as well as causing premature aging.

    The vitamin E value is determined in the serum. The requirement for vitamin E is 11 – 15 mg per day, and this increases continuously the more unsaturated fats are consumed. For example, 0.3 mg of vitamin E is required per gram of monounsaturated fatty acids (e.g. olive oil), and as much as 0.9 mg of vitamin E per gram of polyunsaturated fatty acids.

    When taking vitamin E as a dietary supplement, care should be taken to use natural forms (RRR-alpha-tocopherol) as these are more potent than synthetic forms (alpha-tocopherol).

    Vitamin K: phylloquinone K1 and menaquinone K2

    Vitamin K is known to regulate blood clotting and is also important for bone and blood vessel health. It ensures that calcium gets into the bones and is not deposited in the blood vessels. For this reason, it is usually taken in combination with vitamin D. The latter increases the absorption of calcium from the intestine – and vitamin K is available to ensure that this calcium is distributed correctly in the body.

    Overdosing with vitamin K does not seem to be possible. No overdose symptoms are known, according to specialist literature. Anyone who takes “blood thinners” must discuss vitamin K intake with their doctor, as these drugs lower vitamin K levels.

    Vitamin K levels can be measured in serum, but this is rarely done. Instead, the state of blood clotting (Quick value or INR value) is checked, from which the vitamin K level can be estimated. The higher the INR and the lower the Quick value, the lower the blood clotting and the lower the vitamin K level.
    The official requirement for vitamin K is around 60-80 µg per day, which is the absolute minimum required to regulate blood clotting. This is hardly enough for bone health, so that higher doses of vitamin K (leafy vegetables, herbs, legumes) make a lot of sense.

    Vitamin A (retinol)

    Vitamin A is the eye vitamin. It is important for healthy eyes and good vision. But it is also indispensable for the skin and mucous membranes. Likewise for the bones and teeth. A deficiency manifests itself in poor eyesight, dry skin and dry mucous membranes, increased susceptibility to infections and even an increased risk of cancer.

    The requirement for vitamin A is 0.8 – 1.2 mg or 2600 – 3960 IU (1 mg = 3300 IU). If you want to cover your vitamin A requirement with beta-carotene, then you divide the beta-carotene content of a food by six to get the vitamin A value that the body can produce from it (average).

    Since vitamin A is a fat-soluble vitamin that can be stored in the body, overdoses are possible here. However, beta-carotene (when supplied through the diet) cannot be overdosed.

    Both vitamin A and beta-carotene can be measured in serum.

    Diagnosis of vitamin deficiency and mineral deficiency

    You can have a vitamin deficiency diagnosed by any doctor or naturopath who works with an appropriate laboratory. Some vitamins can also – as already mentioned above – be tested in the home test, e.g. B. Vitamin B12 and vitamin D.

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