Chris, free copper index doesn't make sense to me. Your document says "Free copper index: subtract (ceruloplasmin * 3.15 in mcg/L) from serum copper in mcg/L . This is the free copper." If my patient's serum copper is 95 mcg/dL (950 mcg/L) and ceruloplasmin is 25.6 mg/dL (256,000 mcg/L), with the equation I am getting a free copper of -805,450 and that's nonsense. I'm screwing something up and I'd really appreciate help.
Just noticed the comment below this by Simas and your answer. Another practitioner passed me a free copper equation ~2 years ago and it also gave nonsensical results. Anyway, using the units in your comment to Simas, free copper would equal serum copper in mcg/dL - (ceruloplasmin in mg/dL * 3.15). My patient's serum Cu is 95 mcg/dL and ceruloplasmin is 25.6 mg/dL. That would give a free copper of 69.4 and 73% free copper, both WAY over 15 despite my patient's results looking ideal without this equation.
Hi, Chris. I think there is something wrong with the units when it comes to free copper calculation and in general:
1. "Based on anecdotal experience, I believe the bottom of the reference range is too low and that one should aim to be mid-range, around 90-120 mcg/mL." This should be mcg/dL I believe
2. "Free copper index: subtract(ceruloplasmin * 3.15 in mcg/L) from serum copper in mcg/L. This is the free copper. Divide this by the serum copper to yield the % free copper. If free copper is above 15 or the % free copper is above 15%, seeElevated Free Copperbelow."
There is also something wrong with this formula as well.
E.g. my ceruloplasmin is 0.20 mcg/ml
Serum copper is 58.39 mcg/dL or 0.584 mcg/ml. So 0.584 - 3.15*0.20= -0.0046.
You say you don't see any circumstance for supplementing with more than 1mg folate per day. However, I saw the below case study where a patient was homozygous for a pathogenic variant in SLC191A, and their issues were improved by supplementing with 10mg/day folic acid despite normal levels of serum folate.
I've seen another case study in infants with SLA19A1 mutations where they supplemented them with 2.5mg/day to improve their health.
I'm heterozygous for rs1555874527 in SLC19A1/COL18A which is deemed pathogenic and rare (freq 0.00001556). I also have borderline high MCV (98.5) which has been increasing and symptoms of anemia and anxiety.
Do you think it would be wise to supplement with folinic acid in the range of 2.4mg/day (0.8mg at each meal)? At least until symptoms have improved, then dial back a bit?
If so, would you advise supplementation of other nutrients to prevent imbalances?
Just did some research, and yes, it looks like this variant is more likely to affect COL18A1 instead of SLC19A1. Thanks for this input. Didn't know about the different types of mutations (frameshift vs intron) and the likelihood that they cause problems.
Looking forward to going through BioOpt when I get to the front of the line!
I don't believe hair mineral analysis accurately represents the mineral levels in organ tissue (although it can show mineral transport issues). I'm curious what Masterjohn thinks about OligoScan or similar technologies to measure skin mineral levels?
FWIW, here's Gemini 3 deep think analysis on this cheat sheet:
This analysis evaluates Chris Masterjohn's "Testing Nutritional Status: The Ultimate Cheat Sheet" (Version 3) for potential problems, controversies, or areas where the advice may deviate from mainstream medical consensus.
The document is a highly detailed, biochemically dense resource that offers a comprehensive framework for assessing nutritional status. It demonstrates a sophisticated understanding of nutrient interactions. However, translating this complex information into a practical "cheat sheet" presents several potential issues regarding accessibility, interpretation, and the evidence base for certain recommendations.
Taking into account the typos which break numerous calculations, the reliability of the cheat sheet is further diminished. Given the severity of these objective mistakes—providing dangerous dietary advice, offering broken diagnostic formulas, and falsely indicating lethal toxicities—it would be very dangerous for people to use this as an actual testing reference sheet without meticulously double-checking every calculation, unit conversion, and reference range against established, reliable sources. The practical application—the "Cheat Sheet" aspect itself—is fundamentally broken by these errors.
1. Complexity, Cost, and Accessibility
The most significant practical barrier is the complexity and expense associated with the recommended testing protocols.
Extensive and Expensive Testing: The "Comprehensive Nutritional Screening" (Page 4) relies on specialized functional medicine panels, such as the Genova ION + 40 and the Vibrant America Micronutrient Panel, supplemented by numerous individual tests from standard labs. These panels often cost hundreds or thousands of dollars and are typically not covered by insurance, making the comprehensive approach inaccessible to many.
Interpretation Challenges: The interpretation of panels like the Genova ION, which measures numerous organic acids and amino acids, is highly complex. The guide presents algorithms (Page 5) that imply straightforward interpretations (e.g., elevated alpha-ketoglutarate means thiamin deficiency). In reality, metabolic pathways are complex, and these intermediates can be influenced by diet, stress, microbiome, and genetics, requiring specialized expertise to interpret accurately.
Risk of Self-Diagnosis: Despite a clear disclaimer (Page 1) that the guide is educational and not medical advice, the detailed algorithms and specific action plans inherently encourage self-diagnosis and self-treatment. This is risky, as nutritional markers can be altered by serious underlying medical conditions that require professional diagnosis (e.g., kidney disease affecting magnesium, or anemia of chronic disease mimicking iron deficiency, which the guide acknowledges on Page 53).
2. Narrow "Optimal" Ranges and Over-Optimization
The guide frequently advocates for "optimal" ranges that are significantly narrower than standard laboratory reference ranges. While aiming for optimization is a goal of functional nutrition, defining these ranges too narrowly can lead to overdiagnosis and unnecessary intervention.
Vitamin D: The recommendation to maintain 25(OH)D strictly between 30–40 ng/mL, with concern increasing over 50 ng/mL (Page 15), is notably conservative. Mainstream guidelines generally consider a broader range safe and adequate.
Parathyroid Hormone (PTH): The guide strongly emphasizes suppressing PTH to near or below 30 pg/mL (Page 17) as the primary indicator of calcium/Vitamin D balance. This is a specific interpretation that prioritizes a strict cutoff, which is not the standard clinical approach.
Iron Saturation: The ideal transferrin saturation is narrowly defined as 30% to 40% (Page 52). Treating levels slightly outside this narrow window as problematic may lead to unnecessary intervention if other iron markers are normal.
3. Controversial Interpretation of Genetic Polymorphisms (MTHFR)
The guide places significant weight on common genetic polymorphisms (SNPs), particularly MTHFR, to determine nutritional requirements (Page 36).
Deterministic Approach: The guide suggests precise, quantitative adjustments based on genotype, such as stating the choline requirement is doubled for C677T homozygotes (Page 37). This approach is controversial, as enzyme activity measured in vitro does not always translate directly to clinical outcomes or precise dietary needs, as the body utilizes compensatory pathways.
Deviation from Mainstream Guidelines: Major medical genetics organizations generally recommend against routine MTHFR testing and caution against altering clinical management based solely on these common variants, favoring functional markers (like homocysteine levels) instead.
Speculative Calculations: The suggestion to "guestimate" the combined effect of multiple SNPs by multiplying their residual activities (Page 37) oversimplifies complex biological interactions.
4. Specific Testing Philosophies and Methodologies
Some fundamental testing advice deviates from standard practice, complicating interpretation.
Testing While Supplemented: The guide recommends maintaining supplement use (except high-dose biotin) before testing to reflect the "normal" state (Page 4). Standard practice often involves a washout period to assess baseline status. Testing while supplemented can mask underlying issues; for example, a normal level achieved through high-dose supplementation might indicate poor absorption or high utilization that requires investigation.
Hair Mineral Analysis (HMA): The guide includes Hair Elements as an "Optional Add-On" (Page 4) for assessing minerals like chromium and boron (Page 70). While HMA is accepted for heavy metal exposure, its use for assessing nutritional status of most minerals is highly controversial in mainstream medicine due to issues with external contamination and lack of correlation with tissue stores.
5. High-Dose Supplementation Recommendations
While the guide discusses toxicity, some recommendations for correcting deficiencies involve doses that may be risky without medical supervision.
Vitamin A: The suggestion that 25,000-50,000 IU per day is safe for short-term correction (Page 11) is significantly higher than the established Tolerable Upper Intake Level (UL) of 10,000 IU/day. High doses of preformed Vitamin A carry risks of toxicity.
Vitamin K2: The suggestion that "moderate vitamin K deficiency may be the norm" and the recommendation of 200-1000 mcg/day of K2 for most people (Page 23) is proactive but aggressive, given the lack of established Dietary Reference Intakes (DRIs) specifically for K2.
6. Mixing Established Science with Speculation
The guide is transparent by labeling some information as "Less well established but plausible." However, the inclusion of speculative associations alongside established science may lead users to give undue weight to unproven concepts.
"Overmethylation": The guide discusses symptoms of "Excessive Methylation" (Page 33), such as distractibility and impulsivity. These concepts are not recognized medical diagnoses, and attributing such broad symptoms to methylation status is speculative.
____
Version 3 still contains several critical unit and formula errors that will lead to incorrect lab interpretations (and potentially false panic) if followed literally. Here is a summary of the issues that need fixing for Version 4:
1. Copper Reference Range is Lethal (Page 49) The text states one should aim for serum copper "around 90-120 mcg/mL".
Correction: This must be mcg/dL. 90 mcg/mL is 100x the normal limit and would be lethal toxicity.
2. Free Copper Formula is Broken (Page 5) The formula says: "Subtract (3.15 * ceruloplasmin in mcg/mL) from serum copper in mcg/mL".
Issue: Ceruloplasmin is standardly reported in mg/dL and Serum Copper in mcg/dL. If you convert typical numbers (e.g., Ceruloplasmin 30 mg/dL) to mcg/mL as instructed, the result is negative.
Correction: The formula should use standard units: Serum Copper (mcg/dL) - (3 * Ceruloplasmin in mg/dL).
3. Iron Saturation Calculation (Page 5) The text says to divide iron by transferrin and "multiply by 70.9%".
Issue: Mathematically, multiplying by "70.9%" is multiplying by 0.709. This yields a decimal (e.g., 0.30) rather than the integer needed for the reference range (e.g., 30).
Correction: Multiply by the scalar 70.9, not the percentage.
4. Manganese/Iron Ratio (Page 6) The cheat sheet instructions say to divide Manganese by Iron and multiply by 1000 , but omits the crucial instruction from Page 45 to convert them to the same units first.
Issue: Since Serum Mn is usually ng/mL and Iron is mcg/dL, following Page 6 literally often yields a result >5 (indicating toxicity) for perfectly normal labs.
5. Vitamin A Units (Page 5) The range is given as "0.4 - 0.74" (mg/L), but the guide recommends LabCorp/Quest, which report in mcg/dL (e.g., 38-98).
Issue: A user with a normal "50 mcg/dL" will see it is "above 0.74" and incorrectly assume toxicity.
Correction: Clarify that for LabCorp (mcg/dL), the range is roughly 40 - 74.
6. Vitamin D Typo (Page 15) The conversion text lists "nmol/mL".
Correction: This should be nmol/L.
7. Glycine/Bone Meal Typo (Page 35) The text suggests getting glycine from "3 of an ounce of bone meal".
Issue: "3 of an ounce" is unclear, but more importantly, bone meal is a calcium supplement, not a protein source. Eating ounces of bone meal is dangerous.
I understand that you support continuing supplements before functional testing, and I do the same with my patients. However, I’m curious about your thoughts on B6 supplementation before testing. Some of my patients are on a methylated multivitamin containing 75 mg of Vitamin B6 (as pyridoxine HCl and pyridoxal 5'-phosphate), and their fasting B6 levels often come back significantly elevated—sometimes double the upper limit. This causes concern for them. What are your thoughts on this?
In general I don't think elevated B6 is useful as a marker of neuropathy. The presence of neuropathy is useful as a marker of neuropathy. If they stop the supplement for a week and the level is normal, what insight did you gain?
I will try that and see what comes up having them remove supplements for a week before testing. I understand that pyridoxine HCl has a much shorter half life than pyridoxal 5'-phosphate (hours vs weeks). I guess that if the levels come back to normal in a week, then their p5p clearance is working pretty fast and that I would need to reduce their P5P daily intake. What do you think?
From CheatSheet 3: 'Free copper index: subtract (ceruloplasmin * 3.15 in mcg/L) from serum copper in mcg/L. This is the free copper. Divide this by the serum copper to yield the % free copper. If free copper is above 15 or the % free copper is above 15%, see Elevated Free Copper below.'
My ceruloplasmin is 19.3 mg/dL and serum copper is 13.2 µmol/L;
Conversion: ceruloplasmin 193,000 µg/L; serum copper 838.8072 µg/L; I used unitslab.com for conversion of copper.
If someone wants to get their nutrients tested but is on a feeding tube for part of their nutrition, would the vitamins added to the formula impact lab test results?
Hi Chris, Multiple times in your cheat sheet you recommend the Genova ION + 40 Amino Acids test (test #3102). Going to the provided link at https://www.gdx.net/nutrition, I don't see that test anywhere!
Has it been discontinued? If so, what test(s) do you recommend instead? I was about to order one.
Chris, I believe you used to live in New York & are likely familiar with the legal limitations around Genova testing in this state. Do you have any recommendations for how a New Yorker could get a blood draw for the NutrEval, i.e. via a physician in New Jersey or Connecticut, potentially?
Genova essentially replaced it with Nutreval. If a practitioner had previously run the ION, Genova will still run it on a limited basis for those practitioners. They say the equipment is old and they did/do not have enough equipment to meet the demand for the ION and developed Nutreval. This is what my rep told me, and why is not offered on their physician portal.
Chris, free copper index doesn't make sense to me. Your document says "Free copper index: subtract (ceruloplasmin * 3.15 in mcg/L) from serum copper in mcg/L . This is the free copper." If my patient's serum copper is 95 mcg/dL (950 mcg/L) and ceruloplasmin is 25.6 mg/dL (256,000 mcg/L), with the equation I am getting a free copper of -805,450 and that's nonsense. I'm screwing something up and I'd really appreciate help.
Just noticed the comment below this by Simas and your answer. Another practitioner passed me a free copper equation ~2 years ago and it also gave nonsensical results. Anyway, using the units in your comment to Simas, free copper would equal serum copper in mcg/dL - (ceruloplasmin in mg/dL * 3.15). My patient's serum Cu is 95 mcg/dL and ceruloplasmin is 25.6 mg/dL. That would give a free copper of 69.4 and 73% free copper, both WAY over 15 despite my patient's results looking ideal without this equation.
Hi, Chris. I think there is something wrong with the units when it comes to free copper calculation and in general:
1. "Based on anecdotal experience, I believe the bottom of the reference range is too low and that one should aim to be mid-range, around 90-120 mcg/mL." This should be mcg/dL I believe
2. "Free copper index: subtract(ceruloplasmin * 3.15 in mcg/L) from serum copper in mcg/L. This is the free copper. Divide this by the serum copper to yield the % free copper. If free copper is above 15 or the % free copper is above 15%, seeElevated Free Copperbelow."
There is also something wrong with this formula as well.
E.g. my ceruloplasmin is 0.20 mcg/ml
Serum copper is 58.39 mcg/dL or 0.584 mcg/ml. So 0.584 - 3.15*0.20= -0.0046.
I think copper should be mcg/dL and ceruloplasmin mg/dL.
could you please fix this in the document
Yes, this seems to work well!
Hi Dr CMJ,
You say you don't see any circumstance for supplementing with more than 1mg folate per day. However, I saw the below case study where a patient was homozygous for a pathogenic variant in SLC191A, and their issues were improved by supplementing with 10mg/day folic acid despite normal levels of serum folate.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7330012/
I've seen another case study in infants with SLA19A1 mutations where they supplemented them with 2.5mg/day to improve their health.
I'm heterozygous for rs1555874527 in SLC19A1/COL18A which is deemed pathogenic and rare (freq 0.00001556). I also have borderline high MCV (98.5) which has been increasing and symptoms of anemia and anxiety.
Do you think it would be wise to supplement with folinic acid in the range of 2.4mg/day (0.8mg at each meal)? At least until symptoms have improved, then dial back a bit?
If so, would you advise supplementation of other nutrients to prevent imbalances?
I was speaking generally, I do think with a deletion of a folate transporter higher doses could be tried and judged on their results.
According to dbSNP rs1555874527 is not reported in ClinVar and is an intron variant in SLC19A1.
Not sure where you get pathogenicity from. But it could be pathogenic. Nevertheless I would judge that by serum to cellular folate ratio on Vibrant.
I would use low cellular folate on Vibrant to justify a trial with higher doses of folate.
Vibrant results were
Serum folate High: >20ng/mL
RBC folate Low: 108ng/mL (just barely in reference range on low end)
As for rs1555874527, Genome Explorer on sequencing.com labeled it as Pathogenic.
Maybe it's pathogenic in the COL18A1 (frameshift) gene and not pathogenic in SLC19A1 (intron)?
Thanks for the response.
Just did some research, and yes, it looks like this variant is more likely to affect COL18A1 instead of SLC19A1. Thanks for this input. Didn't know about the different types of mutations (frameshift vs intron) and the likelihood that they cause problems.
Looking forward to going through BioOpt when I get to the front of the line!
As far as I can tell, Sequencing uses some proprietary rating system and I can't make heads or tails out of it.
High serum folate and low RBC folate is consistent with impaired transport. It could also be due to a recent increase in folate intake.
I don't believe hair mineral analysis accurately represents the mineral levels in organ tissue (although it can show mineral transport issues). I'm curious what Masterjohn thinks about OligoScan or similar technologies to measure skin mineral levels?
FWIW, here's Gemini 3 deep think analysis on this cheat sheet:
This analysis evaluates Chris Masterjohn's "Testing Nutritional Status: The Ultimate Cheat Sheet" (Version 3) for potential problems, controversies, or areas where the advice may deviate from mainstream medical consensus.
The document is a highly detailed, biochemically dense resource that offers a comprehensive framework for assessing nutritional status. It demonstrates a sophisticated understanding of nutrient interactions. However, translating this complex information into a practical "cheat sheet" presents several potential issues regarding accessibility, interpretation, and the evidence base for certain recommendations.
Taking into account the typos which break numerous calculations, the reliability of the cheat sheet is further diminished. Given the severity of these objective mistakes—providing dangerous dietary advice, offering broken diagnostic formulas, and falsely indicating lethal toxicities—it would be very dangerous for people to use this as an actual testing reference sheet without meticulously double-checking every calculation, unit conversion, and reference range against established, reliable sources. The practical application—the "Cheat Sheet" aspect itself—is fundamentally broken by these errors.
1. Complexity, Cost, and Accessibility
The most significant practical barrier is the complexity and expense associated with the recommended testing protocols.
Extensive and Expensive Testing: The "Comprehensive Nutritional Screening" (Page 4) relies on specialized functional medicine panels, such as the Genova ION + 40 and the Vibrant America Micronutrient Panel, supplemented by numerous individual tests from standard labs. These panels often cost hundreds or thousands of dollars and are typically not covered by insurance, making the comprehensive approach inaccessible to many.
Interpretation Challenges: The interpretation of panels like the Genova ION, which measures numerous organic acids and amino acids, is highly complex. The guide presents algorithms (Page 5) that imply straightforward interpretations (e.g., elevated alpha-ketoglutarate means thiamin deficiency). In reality, metabolic pathways are complex, and these intermediates can be influenced by diet, stress, microbiome, and genetics, requiring specialized expertise to interpret accurately.
Risk of Self-Diagnosis: Despite a clear disclaimer (Page 1) that the guide is educational and not medical advice, the detailed algorithms and specific action plans inherently encourage self-diagnosis and self-treatment. This is risky, as nutritional markers can be altered by serious underlying medical conditions that require professional diagnosis (e.g., kidney disease affecting magnesium, or anemia of chronic disease mimicking iron deficiency, which the guide acknowledges on Page 53).
2. Narrow "Optimal" Ranges and Over-Optimization
The guide frequently advocates for "optimal" ranges that are significantly narrower than standard laboratory reference ranges. While aiming for optimization is a goal of functional nutrition, defining these ranges too narrowly can lead to overdiagnosis and unnecessary intervention.
Vitamin D: The recommendation to maintain 25(OH)D strictly between 30–40 ng/mL, with concern increasing over 50 ng/mL (Page 15), is notably conservative. Mainstream guidelines generally consider a broader range safe and adequate.
Parathyroid Hormone (PTH): The guide strongly emphasizes suppressing PTH to near or below 30 pg/mL (Page 17) as the primary indicator of calcium/Vitamin D balance. This is a specific interpretation that prioritizes a strict cutoff, which is not the standard clinical approach.
Iron Saturation: The ideal transferrin saturation is narrowly defined as 30% to 40% (Page 52). Treating levels slightly outside this narrow window as problematic may lead to unnecessary intervention if other iron markers are normal.
3. Controversial Interpretation of Genetic Polymorphisms (MTHFR)
The guide places significant weight on common genetic polymorphisms (SNPs), particularly MTHFR, to determine nutritional requirements (Page 36).
Deterministic Approach: The guide suggests precise, quantitative adjustments based on genotype, such as stating the choline requirement is doubled for C677T homozygotes (Page 37). This approach is controversial, as enzyme activity measured in vitro does not always translate directly to clinical outcomes or precise dietary needs, as the body utilizes compensatory pathways.
Deviation from Mainstream Guidelines: Major medical genetics organizations generally recommend against routine MTHFR testing and caution against altering clinical management based solely on these common variants, favoring functional markers (like homocysteine levels) instead.
Speculative Calculations: The suggestion to "guestimate" the combined effect of multiple SNPs by multiplying their residual activities (Page 37) oversimplifies complex biological interactions.
4. Specific Testing Philosophies and Methodologies
Some fundamental testing advice deviates from standard practice, complicating interpretation.
Testing While Supplemented: The guide recommends maintaining supplement use (except high-dose biotin) before testing to reflect the "normal" state (Page 4). Standard practice often involves a washout period to assess baseline status. Testing while supplemented can mask underlying issues; for example, a normal level achieved through high-dose supplementation might indicate poor absorption or high utilization that requires investigation.
Hair Mineral Analysis (HMA): The guide includes Hair Elements as an "Optional Add-On" (Page 4) for assessing minerals like chromium and boron (Page 70). While HMA is accepted for heavy metal exposure, its use for assessing nutritional status of most minerals is highly controversial in mainstream medicine due to issues with external contamination and lack of correlation with tissue stores.
5. High-Dose Supplementation Recommendations
While the guide discusses toxicity, some recommendations for correcting deficiencies involve doses that may be risky without medical supervision.
Vitamin A: The suggestion that 25,000-50,000 IU per day is safe for short-term correction (Page 11) is significantly higher than the established Tolerable Upper Intake Level (UL) of 10,000 IU/day. High doses of preformed Vitamin A carry risks of toxicity.
Vitamin K2: The suggestion that "moderate vitamin K deficiency may be the norm" and the recommendation of 200-1000 mcg/day of K2 for most people (Page 23) is proactive but aggressive, given the lack of established Dietary Reference Intakes (DRIs) specifically for K2.
6. Mixing Established Science with Speculation
The guide is transparent by labeling some information as "Less well established but plausible." However, the inclusion of speculative associations alongside established science may lead users to give undue weight to unproven concepts.
"Overmethylation": The guide discusses symptoms of "Excessive Methylation" (Page 33), such as distractibility and impulsivity. These concepts are not recognized medical diagnoses, and attributing such broad symptoms to methylation status is speculative.
____
Version 3 still contains several critical unit and formula errors that will lead to incorrect lab interpretations (and potentially false panic) if followed literally. Here is a summary of the issues that need fixing for Version 4:
1. Copper Reference Range is Lethal (Page 49) The text states one should aim for serum copper "around 90-120 mcg/mL".
Correction: This must be mcg/dL. 90 mcg/mL is 100x the normal limit and would be lethal toxicity.
2. Free Copper Formula is Broken (Page 5) The formula says: "Subtract (3.15 * ceruloplasmin in mcg/mL) from serum copper in mcg/mL".
Issue: Ceruloplasmin is standardly reported in mg/dL and Serum Copper in mcg/dL. If you convert typical numbers (e.g., Ceruloplasmin 30 mg/dL) to mcg/mL as instructed, the result is negative.
Correction: The formula should use standard units: Serum Copper (mcg/dL) - (3 * Ceruloplasmin in mg/dL).
3. Iron Saturation Calculation (Page 5) The text says to divide iron by transferrin and "multiply by 70.9%".
Issue: Mathematically, multiplying by "70.9%" is multiplying by 0.709. This yields a decimal (e.g., 0.30) rather than the integer needed for the reference range (e.g., 30).
Correction: Multiply by the scalar 70.9, not the percentage.
4. Manganese/Iron Ratio (Page 6) The cheat sheet instructions say to divide Manganese by Iron and multiply by 1000 , but omits the crucial instruction from Page 45 to convert them to the same units first.
Issue: Since Serum Mn is usually ng/mL and Iron is mcg/dL, following Page 6 literally often yields a result >5 (indicating toxicity) for perfectly normal labs.
5. Vitamin A Units (Page 5) The range is given as "0.4 - 0.74" (mg/L), but the guide recommends LabCorp/Quest, which report in mcg/dL (e.g., 38-98).
Issue: A user with a normal "50 mcg/dL" will see it is "above 0.74" and incorrectly assume toxicity.
Correction: Clarify that for LabCorp (mcg/dL), the range is roughly 40 - 74.
6. Vitamin D Typo (Page 15) The conversion text lists "nmol/mL".
Correction: This should be nmol/L.
7. Glycine/Bone Meal Typo (Page 35) The text suggests getting glycine from "3 of an ounce of bone meal".
Issue: "3 of an ounce" is unclear, but more importantly, bone meal is a calcium supplement, not a protein source. Eating ounces of bone meal is dangerous.
Correction: Likely meant Bone Broth or Collagen.
I understand that you support continuing supplements before functional testing, and I do the same with my patients. However, I’m curious about your thoughts on B6 supplementation before testing. Some of my patients are on a methylated multivitamin containing 75 mg of Vitamin B6 (as pyridoxine HCl and pyridoxal 5'-phosphate), and their fasting B6 levels often come back significantly elevated—sometimes double the upper limit. This causes concern for them. What are your thoughts on this?
In general I don't think elevated B6 is useful as a marker of neuropathy. The presence of neuropathy is useful as a marker of neuropathy. If they stop the supplement for a week and the level is normal, what insight did you gain?
I will try that and see what comes up having them remove supplements for a week before testing. I understand that pyridoxine HCl has a much shorter half life than pyridoxal 5'-phosphate (hours vs weeks). I guess that if the levels come back to normal in a week, then their p5p clearance is working pretty fast and that I would need to reduce their P5P daily intake. What do you think?
I would think if reducing P5P resolved neuropathy, the P5P was the cause of the neuropathy, and the testing is a waste of time.
Hi Chris,
From CheatSheet 3: 'Free copper index: subtract (ceruloplasmin * 3.15 in mcg/L) from serum copper in mcg/L. This is the free copper. Divide this by the serum copper to yield the % free copper. If free copper is above 15 or the % free copper is above 15%, see Elevated Free Copper below.'
My ceruloplasmin is 19.3 mg/dL and serum copper is 13.2 µmol/L;
Conversion: ceruloplasmin 193,000 µg/L; serum copper 838.8072 µg/L; I used unitslab.com for conversion of copper.
Calc: 19.3 µg/L x 3.15 = 607950 µg/L;
838.8072 µg/L - 607950 µg/L= -607,111.1928 µg/L -> free copper
-607,111.1928 µg/L : 838.8072 µg/L = ~ -723,78 %
This makes no sense - but I can't find the mistake
free copper as calculated by the lab is 2.87 µmol/L
If someone wants to get their nutrients tested but is on a feeding tube for part of their nutrition, would the vitamins added to the formula impact lab test results?
Some of them, but not in a way that makes testing not useful.
Hi Chris, Multiple times in your cheat sheet you recommend the Genova ION + 40 Amino Acids test (test #3102). Going to the provided link at https://www.gdx.net/nutrition, I don't see that test anywhere!
Has it been discontinued? If so, what test(s) do you recommend instead? I was about to order one.
thanks.
Doctors can order it inside their portal and DTC companies like truehealthlabs should allow you to order it. If all else fails get the NutrEval.
Chris, I believe you used to live in New York & are likely familiar with the legal limitations around Genova testing in this state. Do you have any recommendations for how a New Yorker could get a blood draw for the NutrEval, i.e. via a physician in New Jersey or Connecticut, potentially?
Genova essentially replaced it with Nutreval. If a practitioner had previously run the ION, Genova will still run it on a limited basis for those practitioners. They say the equipment is old and they did/do not have enough equipment to meet the demand for the ION and developed Nutreval. This is what my rep told me, and why is not offered on their physician portal.
You can get it through Rupa or through truehealthlabs.