“I strongly believe that food is medicine and that it should be not an afterthought in medicine but the foundation of medical practice. There is no better drug on the planet.” -Dr. Mark Hyman.
Assessing a patient’s nutritional status has always been a fundamental part of the medical record, but most of the time is not explored in an in-depth way. In Functional Medicine, we understand that diet has a strong influence on our metabolism. The energy that we consume from our diet and the vitamins and minerals are the foundation of our cellular and genetic function, nutrition has never been more important. Each of these cellular processes and reactions needs enzymes, and every one of these compounds needs a helper, a co-enzyme, where vitamins and minerals play a significant role.
Health care professionals know everything there is to know about acute nutritional deficiencies such as rickets, which reflects a deficiency of vitamin D, scurvy for low vitamin C levels, or iron deficiency anemia. We are here to know about the optimal vitamin and mineral levels and how they work.
Vitamin D: The function of vitamin D was previously related to calcium absorption and bone metabolism, but it turns out it has more therapeutic applications, and it can be classified as a pro-hormone. The Food and Nutrition board previously recommended 2000IU/day of vitamin D to be used as an upper limit, but recent research has found that adults’ requirements may be as high as 5000IU/day. It has been determined that higher levels of vitamin D are associated with protection from diabetes mellitus, osteoporosis, osteoarthritis, hypertension, cardiovascular disease, metabolic syndrome, and a wide range of cancers.
MCV: This stands for mean corpuscular volume, this is part of a test that is called complete blood count, and it measures the size of our red cells. MCV can tell us whether vitamin B12 or folate is deficient in our body. B vitamins are essential for several metabolic reactions in our body and provide methyl groups to normalize gene expression.
Normal: 70-100fL/red cell
Optimal: 80-90fL/red cell
Methylmalonic Acid (MMA): This is a Vitamin B 12 marker. Vitamin B12 plays a major factor in neurological function, red blood cell formation, and DNA. It also has a vital function as a co-factor, helping processes that help the conversion of homocysteine to methionine, which is a universal methyl donor for almost 100 different substrates, such as DNA, RNA, hormones, proteins, and lipids.
Normal: 0-378 nmol/L
Optimal: < 300 nmol/L
MTHFR: This is an enzyme that plays a key role in the metabolism of folate, polymorphisms of MTHFR are associated with cancer susceptibility, neural tube defects, and an increased risk of heart disease. High levels of homocysteine (<8) are associated with a dysregulation of MTHFR with a close relationship with a polymorphism at nucleotide 667; therefore, evaluating the status of this nucleotide is the one to be tested. The main thing that there is to explain is this: not every mutation derives from a problem, and if there is more than one mutation, the treatment is to change the supplementation to methyl folate.
C677 is the most clinically important gene: no mutations = lowest risk factor, two mutations = highest risk
MTHFR (A1298C): no mutations= lowest risk factor, two mutations = highest risk
RBC magnesium: Mg function is bound to 300 metabolic reactions because it releases phosphate from ATP in chemical reactions. This mineral is essential for the correct function of energy-related metabolic cycles. Some symptoms associated with a magnesium deficiency are constipation, anxiety, insomnia, palpitations, PMS, and muscle cramps.
Normal: 1.5-2.5 mEq/L
Optimal: 2.0-2.5 mEq/L
Zinc: This element is one of the most common in the human body; it has many functions. Zinc has been known to have an important role as an enzyme catalyzer in the metabolism of proteins, carbohydrates, and lipids. More recently, it has been reported that zinc can regulate cytokine expression, therefore having an anti-inflammatory effect and having an antioxidant effect.
Normal: 0.66 to 1.10 mcg/mL
HbA1C: Hemoglobin A1c is a routine test to evaluate if the glucose of a diabetic person (or someone trying to keep track of their glucose) has been under control for the last 6 – 8 weeks.
Normal: 4.8% – 5.6% • Optimal: 4.8% – 5.5 %
Optimal: 4.8% – 5.5 %
Ferritin: Iron is stored as ferritin; this is why the assessment of ferritin is an important measurement of iron status, and it is considered differential diagnoses of anemic conditions.
Normal men: 30-400 ng/mL
Optimal men: 100-300 ng/mL
Normal women: 15-150 ng/mL
Optimal women: 50-150 ng/mL
Vasquez, Alex, Gilbert Manso, and John Cannell. “The clinical importance of vitamin D (cholecalciferol): a paradigm shift with implications for all healthcare providers.” Alternative Therapies in Health and Medicine 10.5 (2004): 28.
Pitkin, Roy M., et al. “Dietary Reference Intakes for Thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, Pantothenic acid, biotin and choline.” Washington, DC (2000).
González-Galofre, Z. N., Villegas, V., & Martínez-Agüero, M. (2010). Preliminary population study of Methylenetetrahydrofolate Reductase (MTHFR) C677T polymorphism determination in a pilot group of students from the University of Rosario. Revista Ciencias De La Salud, 8(1). Retrieved from https://revistas.urosario.edu.co/index.php/revsalud/article/view/121
Olechnowicz, J., et al. “Zinc status is associated with inflammation, oxidative stress, lipid, and glucose metabolism.” The Journal of Physiological Sciences 68.1 (2018): 19-31.
Hyman, Mark. “Nutrition.” Commune, 2020, http://www.onecommune.com/products/hacking-your-healthcare-with-dr-mark-hyman/categories/1653473/posts/2929882.