Nutrition & B-Vitamin biomarkers
B-vitamins, iron, omega-3 status, and intracellular micronutrient sufficiency.
Key takeaways
- MMA detects functional B12 insufficiency before serum B12 falls.
- Ferritin rises with inflammation, so when it looks normal, transferrin saturation helps reveal iron deficiency that ferritin alone would hide.
- The omega-3 index is desirable above 8%, with a proposed optimum of roughly 8 to 11%, well above the standard sufficiency cutoff.
- Nutrient repletion is one of the fastest-moving parts of any protocol.
B12 and Folate. B12 deficiency without anemia is associated with neurological symptoms and cognitive changes. Standard normal ranges extend too low to reflect optimal neurological function. Standard: B12 200 to 900 pg/mL, Folate 2.7 to 17 ng/mL. Optimal: B12 500 to 1,000 pg/mL, Folate 15 to 20 ng/mL. Moved by: methylcobalamin B12, methylfolate, dietary sources like meat, eggs, and dairy.
MMA (Methylmalonic Acid). A functional marker of B12 status. MMA rises before blood B12 levels fall, making it the earlier and more sensitive indicator of functional B12 insufficiency. Standard: under 0.40 umol/L. Optimal: under 0.20 umol/L. Moved by: active B12 supplementation (methylcobalamin or adenosylcobalamin).
Iron, TIBC, Ferritin, and TSAT. Iron deficiency without frank anemia is a common cause of fatigue, poor recovery, and cognitive symptoms. Ferritin alone can mislead, since it rises with inflammation independent of iron status. TSAT (transferrin saturation) is what tells apart true iron deficiency from iron trapped by inflammation. Standard: ferritin 12 to 300 ng/mL (men), 12 to 150 (women). Optimal: ferritin 50 to 150 ng/mL, TSAT 25 to 35%. Moved by: dietary iron optimization, supplementation if indicated, evaluation for blood loss or underlying inflammation.
Micronutrient Panel. Evaluates functional intracellular status of key vitamins and minerals including zinc, magnesium, selenium, vitamin C, E, CoQ10, and B-vitamins. Standard: individual reference ranges per nutrient. Optimal: functional sufficiency across all key nutrients. Moved by: targeted supplementation based on identified deficiencies, dietary optimization.
Omega Panel. Chronic low omega-3 status is associated with systemic inflammation, cardiovascular risk, cognitive decline, and inflammatory skin conditions. Standard: omega-3 index above 4%. Optimal: omega-3 index above 8%, with a proposed optimum of roughly 8 to 11%, and an omega-6 to omega-3 ratio under 4 to 1. Moved by: EPA/DHA supplementation 2 to 4g/day, dietary shift away from omega-6 dominant seed oils.
What this means for you
Fatigue with a normal CBC is frequently iron or B12 at a functional level. TSAT and MMA are the tests that find it.