Please click on the test links given below to see more detail, collection instructions, sample reports etc...
This is a really complex field and you would think it would be so easy! The fact is that different nutrients are best tested in different ways. However, thankfully, there are some good all-rounders. In this section, I have listed the most useful tests although I could have listed many more! Do ask if you need something else.
There are basically two main ways of testing nutrients: functional testing using amino acid analysis and metabolic testing to find functional issues with nutrient use in the body OR testing actual levels in blood, urine or hair etc. Nutreval and the the ION Profile below do both.
I am often asked to choose between the different methods. Put simply: I can't. It is like comparing apples with eggs, or something like that! They do completely different things, but both will give you an idea of which nutrient levels might be an issue.
You will also notice I have included the Low Stomach Acid Factsheet in Resources above. Why? because many people are deficient in vitamins and minerals simply because they are not digesting well enough. Sort that too.
I rate the Nutreval (needs centrifuging), ION Profile and the ONE Test, which is a smaller version of the bigger tests, but often gives people a good indication of what's going on. I like these particularly because they give you a suggested supplement level protocol based on your results which you can then follow more easily! Check the sample reports to see what you get with each one. (Please Note: March 18: the ION Profile does not include the supplement recommendations bit of the report at the moment as they are redeveloping it, but you still get it with the ONE.)
In effect, Nutreval includes body level testing of minerals as well as functional testing, extra antioxidants and fatty acids on top of everything you get in the ONE test. The ION Profile also includes functional testing but more direct testing of the minerals and fatty acids. If I could choose a standard work-up, the ION Profile would be it, but it costs..
Body Level Tests
This is quite complex and there seem to be dozens of ways of looking for nutrient levels.
To make life even more complicated, different test types are best for different minerals.
My main recommendation nowadays for minerals is Genova's Nutrient & Toxic Elements Blood Test because it measures the different minerals and toxic metals like mercury etc in the different ways, which I think is rather clever of them. Happily, this one doesn't need centrifuging but do please get it back within the 24 hours. (Incidentally, you can do this via Urine too but I think blood is better myself for the main minerals; this one might be useful if on a chelation programme though eg, for toxic metals). I haven't listed it to save confusion.
Magnesium is the most crucial mineral in my mind and it is included on here for that reason in several guises -it is best tested as red blood cell and you can do the Biolab RBC Mg test on its own and it comes as part of the Genova Elements test above.
Hair can also be useful and shows you likely levels 3-4 months ago. A good one here is the DD Hair Elements Test. The Mineral Check hair test gives more info on ratios, so can be a better alternative if you are looking for general health indicators such as adrenal or thyroid issues as well as toxic metals. The reporting on the DD one is really good for where the minerals might be coming from, whereas the Mineral Check is good for the ratios and extra info. Here is a useful FAQ on hair testing from Mineral Check and some instructions on how to do a hair test effectively. A tip on the Mineral Check hair test - you can do a graph-only follow up if you wish rather than a full report. However, it costs only £10 less so I would say a full report is always better value. If you are doing a follow-up test, make sure you add the previous test reference number on the sample envelope - the company will include the previous figures on the report so you can make an easy comparison.
I would combine the Elements blood test with the Biolab Comprehensive Vitamin Profile.
It includes Vitamin A, C, D, E carotenes, B1, B2, B6, active B12 and red cell folate. The reason I recommend this one is that Biolab do functional Vitamin B testing. If you simply do serum levels as most labs do, you only get a very recent snapshot as B vits are water soluble. Functional testing shows you likely 'real' levels. You also get active vitamin B12 and red cell folate rather than simple serum (see more on this below).
You can, of course, do any of those elements separately if you need that, and you can add Niacin (B3) if you need to; just ask.
Ensuring Vitamin D is becoming more and more crucial. You can do a simple 25-OH DD fingerprick Vitamin D status or I have added the Vitamin D 1,25 Dihydroxy test which is more for renal and parathyroid issues. You can read more about that here. It did used to be collection at London lab only but I double-checked and they can now do it as an ambient, unspun, sample if we can receive within 2 - 3 days so no need to centrifuge or freeze anymore, yay.
Another useful addition is Genova Blood Spot Fatty Acids too if necessary (ie. especially fatigue, inflammation, pain, neurological issues present). Note: you can get much more complex fatty acid testing too but this, I think, is enough for most needs.
An extra word on Anaemia and B12 testing: The TDL Anaemia test is the best around because it looks for red blood cell folate, active B12 and inflammation scores which can affect how you interpret the results. Some people want to check for a B12 deficiency using MMA (methylmalonic acid), which is a functional test - actually included in the ONE and Nutreval above too - that can sometimes show a hidden B12 problem if normal B12 results look OK. To help, you can do the Biolab Active B12 and MMA Test. Or just MMA (in urine, for ease) on its own too.
Those of you on statins should be checking your CoQ10 levels since those meds are known to deplete this important DNA, heart, energy and brain nutrient. A lack of CoQ10 is also thought to be a possible cause of the common muscle pain side effects, so I have added Biolab's CoQ10 Test for you.
I told you this was complex! If in doubt, go for an overall test - either the ONE, ION or Nutreval OR the Nutrient & Toxic Elements (blood) and Comprehensive Vitamin Profile. Add things like Anaemia or Fatty Acid levels as needed.
As I have said, you can test pretty much anything. The test list here could be as long as your arm so I am not listing much except the most popular ones. Ask if you need something else.
I've added red blood cell magnesium as I get asked for it a lot, but you can also do copper, zinc, niacin, selenium or whatever, just ask. The standard vitamins and minerals are usually about £45-50 each so the Genova Elements profile above is often better value. More specialist elements like CoQ10, glutathione etc vary. Just use the Lab Test Request form if you need something and I will confirm the price.
Iodine and Halides
Iodine Loading is very useful, especially to help find reasons for thyroid hormone conversion problems. You can do standard iodine too, of course, but I am listing loading as well as I find it more clinically useful. You can also add bromine and flourine to the iodine as the Halides Loading test if you need that - I get asked a lot so I have listed it for you as an option.
This Halides loading test can also give you an indication of so-called Symporter iodine transport problems if you have read about that. I've mentioned more about this below in the Q&A and linked to a factsheet for more info there too.
Heavy Metal Testing
I've put this updated section now on the Specific Conditions page with the other environmental exposure tests.
Testing Hints & Tips:
Follow the instructions on each test page on the lab websites. I have added stuff here if I commonly get asked about it! Note that several of the tests need centrifuging so do please read the test FAQ for how to do this if you are not near the labs. Do not order unless you have sorted how to get this done, thanks.
Stop any iron or folate supplements for 48 hours before unless monitoring on them. The active B12 lab advises stopping B12 supplements for 2-3 weeks before this specific type of B12 test.
Red Blood Cell Minerals:
Can someone with thalassaemia have a red blood cell mineral test done OK?
I checked with the lab and they said that neither the size nor shape of the cell matters as they break them open anyway to do the test process. However, if the cell is too fragile and breaks during centrifuging (which some tests needs to have done), and there are regularly signs of haemolysis, then there would be a problem. In that case, they advise whole blood testing instead rather than red blood cell.
Iodine Loading (I get asked a lot on this one so here goes..):
This test kit comes from Regenerus in the UK. You will receive return instructions in your kit. Basically, you can use their courier (UPS label included in the kit for £9 which you pay Regenerus for if you use it), or your own methods to post your sample back to the UK lab. They will then drop-ship it to the US lab for you. Please read the Test FAQ for more info on shipping generally.
How do I do the test?
You take a urine sample when you get up in the morning, put it in the 'Pre' vial, label that and then take your loading dose of 50mg of Iodoral; that's all 4 tablets together (unless your health professional advises otherwise, of course). From then on, you collect your urine every time you go for the next 24 hours or until you fill the 4 litre jug. You then shake the jug to mix the urine up a bit, write down the total volume of urine collected in the post section on the form (should be max 4000ml obviously but might be under that), then take a sample and put it in the 'post' vial, labelling it correctly. Ignore the Excess volume bit of the form; it's just confusing and you don't need it. You then package your samples up, following the instructions and packaging given in your kit. Make sure your form is filled in completely - especially the pre and post urine volume amounts which are crucial otherwise they can't calculate your results properly - and put it with the samples (otherwise it will be rejected) and Bob's your Uncle.
Will I get iodine tablets in the kit?
Yes, 4 x 12.5mg Iodoral tablets for the challenge test are included with your kit.
What if I collect more than 4000ml of urine over the 24 hours?
It does say to stop at 4000ml so you just fill the jug up to the fill line and then discard the rest.
Do I have to avoid anything?
With this test, you need to avoid any iodine supplements and iodine rich foods like seafood, kelp, fish (see the instructions in the kit) for 48 hours before the test. You don't need to stop any other supplements but I often say if unsure stop all supplements for 48 hours to be sure.
I am on thyroxine/Armour, can I still do the test?
The lab advises that thyroxine and other thyroid boosters like Armour should not interfere with results but you need to be careful of over-stimulating your thyroid and be led by your health professional. If you have autoimmune thyroiditis or hyperthyroidism, for example, taking the iodine could cause a thyroid storm so do please talk to your health professional to be safe. I have never known it, but that's what the lab advises. If taking the test, it is best to take the loading dose well away from your thyroxine or Armour.
I am on other meds, can I still do the test?
Probably. Here is a list of interactions of meds with iodine. Check with your health professional - and often a local pharmacist can be very helpful.
I urinate a lot, will I have to drink less on the day of the test?
There is an option to take a representative sample of your urine anyway. You measure the total volume first and write that on the form. I would trial a normal day and measure what you usually pass and cut down if it is beyond the reference range given on the test instructions.
I see the test measures creatinine. I do a lot of exercise which I read raises creatinine. Does this matter?
The creatinine is only used as a baseline to measure urine concentration levels so they can calculate the retention levels etc. Exercise, raised or low creatinine levels serve no diagnostic purpose here and therefore won't affect your results.
Does the urine sample have to be frozen?
No, not even if sending from Europe.
Do I have to take the loading dose with food?
It's always best to take supplements with food so I would have it with a bit of a snack, although it doesn't matter for your test results.
I have heard that I could have a Symporter transport problem with iodine. Can you test for that?
We don't do an actual Symporter test as it is very unwieldy to do and hard to get done in the UK. However, we do know that one of the main causes of a symporter issue is high halides, so do the Halides Loading test first and, if those are high, you have your answer. If the halides are low, you've ruled that cause out, but there are others including genetic defects, goitrogens, some pesticides and oxidative stress, to name a few. There is useful, if pretty technical, factsheet here for you on Symporter transport testing and treatment.