Vitamin Status

Introduction

Vitamins are essential micronutrients required for a wide array of physiological functions. They contribute to metabolic pathways, immune function, neurological function, bone health, and cellular integrity. Despite their small required quantities, imbalances—both deficiencies and excesses—can significantly affect overall health and increase the risk of chronic disease. Evaluating vitamin status plays a central role in functional medicine, where early detection of subtle imbalances can inform preventive strategies and support individualized patient care.

Background

Vitamin imbalances are multifactorial. Deficiencies may arise from inadequate dietary intake, impaired digestion, poor absorption, increased physiological demands, or medication interactions. Conversely, excessive supplementation or underlying metabolic dysfunction may lead to vitamin excess and potential toxicity.
The assessment of vitamin status is more than identifying deficiency states. A comprehensive approach considers dietary patterns, gastrointestinal function, metabolic capacity, transport mechanisms, and tissue uptake. Functional medicine expands the traditional scope of lab testing by evaluating suboptimal patterns before they reach overt clinical deficiency or toxicity.

Clinical Presentation

Symptoms associated with vitamin imbalances are nonspecific and often overlap with other clinical conditions. However, certain presentations can raise suspicion for micronutrient–related issues:

• Fatigue and Weakness: Commonly associated with deficiencies in B-complex vitamins, vitamin D, and iron.
• Dermatological Issues: Dry skin, rashes, or acne may reflect imbalances in vitamins A, D, E, or B2.
• Mood Disturbances: Depression, anxiety, and irritability may be associated with low levels of vitamins B6, B12, and D.
• Cognitive Impairment: Difficulty concentrating, memory loss, and brain fog may relate to deficiencies in B12, folate, or E.
• Bone Pain or Fragility: May suggest vitamin D and K imbalances, particularly when combined with calcium dysregulation.
• Frequent Infections: A hallmark of weakened immune function potentially linked to low vitamin D, C, or A.
  
  

Diagnostic Evaluation

The evaluation of vitamin status begins with a detailed patient history and physical exam, followed by targeted laboratory testing:

• Serum or Plasma Vitamin Panels: Assess levels of vitamins A, C, D (25-hydroxy), E, and K, as well as water-soluble B-complex vitamins, including B1 (thiamine), B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin), and folate.
• Functional Markers:
• Elevated homocysteine signals B6/B12/folate issues.
• Elevated methylmalonic acid (MMA) indicates intracellular B12 deficiency.
• Low holotranscobalamin reflects reduced bioavailable B12.
• High RDW may accompany macrocytic anemia.
• Low 25-hydroxyvitamin D defines vitamin D insufficiency.
• Dietary and Lifestyle Review: Identifies insufficiencies, alcohol/tobacco use, or sunlight deficits.
• Gastrointestinal Function Testing: For suspected malabsorption (e.g., celiac, Crohn’s, SIBO).
  
  

Reference Ranges and Interpretation

While reference ranges vary, functional medicine targets levels that support optimal physiology. Examples:

• 25(OH)D: Deficient <20 ng/mL; Insufficient 20–30 ng/mL; Optimal 40–60 ng/mL.
• Vitamin B12: Deficient <200 pg/mL; Functional <400 pg/mL with elevated MMA.
• Folate: Optimal >5.5 ng/mL (interpret alongside homocysteine).
  
  

Interfering Factors

• Age: Diminished gastric acid impacts B12 and iron absorption.
• Digestive Enzyme Insufficiency: Impairs fat-soluble vitamin uptake (A, D, E, K).
• Chronic Stress: Increases demand for B-complex and vitamin C.
• Alcohol Consumption: Reduces B-vitamin absorption and increases excretion.
• Low Sunlight Exposure: Limits cutaneous vitamin D synthesis.
  
  

Medication-Induced Changes in Vitamin Status

Clinical Implications of Vitamin Imbalances

• Bone Health: D & K deficiencies → osteoporosis/fracture risk.
• Anemia: B12/folate deficiency → megaloblastic anemia; iron deficiency anemia.
• Neurological Symptoms: B12/E deficiency → neuropathy, cognitive decline.
• Cardiovascular Risk: ↑ homocysteine from folate/B12 deficit → endothelial dysfunction.
• Skin Disorders: A/D/E deficiencies → eczema, psoriasis, acne.
• Immune Function: A & D deficiencies → impaired infection defense.
  
  

Functional Medicine Approach to Vitamin Optimization

In a functional medicine framework, vitamin evaluation is foundational. Interventions are tailored to:

• Laboratory Evidence: Correct lab-identified deficiencies.
• Root Cause: Address malabsorption, diet, or drug interactions.
• Individualized Supplementation: Therapeutic dosing with monitoring to avoid toxicity.
• Lifestyle Modification: Nutrient-dense diet, hydration, stress management, and exercise.

Conclusion

A comprehensive evaluation by a functional medicine practitioner in Florida identifies and corrects cellular and molecular imbalances in vitamin status. By integrating evidence-based nutrition strategies with IV Therapy and Longevity Medicine services—where rapid micronutrient delivery and systemic support are paramount—we offer a regenerative, preventive framework to optimize metabolic, immune, and musculoskeletal health. Call (904) 799-2531 or schedule online.

Further Reading

• Biesalski HK. “Vitamins and Minerals—Principles and Roles in Health and Disease.” Nutrients. 2020;12(6):1801. https://doi.org/10.3390/nu12061801
  

• Bailey RL, West KP Jr, Black RE. “The Epidemiology of Global Micronutrient Deficiencies.” Ann Nutr Metab. 2015;66 Suppl 2:22–33. https://doi.org/10.1159/000371618
  

• Allen LH. “Causes of Vitamin B12 and Folate Deficiency.” Food Nutr Bull. 2008;29(2 Suppl):S20–S34. https://doi.org/10.1177/15648265080292S204
• Holick MF. “The Vitamin D Deficiency Pandemic: Approaches for Diagnosis, Treatment and Prevention.” Rev Endocr Metab Disord. 2017;18(2):153–165. https://doi.org/10.1007/s11154-017-9424-1