Bloodwork Basics: When Testing Makes Sense

"Should you get routine blood work?" seems like a straightforward question, but the answer lies in understanding how our bodies process nutrients and when testing actually provides meaningful information. 

Nutrient deficiencies can be surprisingly sneaky, calcium deficiencies might take decades to show up in blood tests while silently damaging bone health, and even B12 deficiencies can remain hidden for 6-12 months before symptoms emerge.

For those following or transitioning to plant-based diets, there's particular interest in monitoring nutritional status, but ordering "everything" on a blood panel isn't always the right approach. 

When we test without specific reasons, we often find incidental fluctuations that trigger unnecessary follow-up procedures, creating anxiety and straining healthcare resources. 

A better strategy is targeted testing based on your specific risk factors, symptoms, and dietary patterns. Pregnant or breastfeeding individuals, those taking medications like metformin or regular antacids, people with relevant family histories, and anyone on restrictive diets might benefit from more comprehensive screening.

Before reaching for the needle, consider tracking your nutrition through tools like the Canadian Food Guide, Dr. Greger's Daily Dozen Checklist, or apps like Cronometer to identify potential gaps. 

When testing makes sense, a complete blood count and metabolic profile provide foundational information, while specific nutrient tests can be added based on individual needs. 

Remember that for plant-based eaters, B12 supplementation remains essential regardless of blood test results, some deficiencies simply take too long to appear in testing. 

The ultimate goal isn't just finding problems after they develop but preventing them through varied, nutrient-dense foods and lifestyle habits that support overall health. 

Visit plantbaseddrjules.com for more resources on optimizing your nutrition through thoughtful, evidence-based approaches.

Go check out my website for tons of free resources on how to transition towards a healthier diet and lifestyle.

You can download my free plant-based recipes eBook and a ton of other free resources by visiting the Digital Downloads tab of my website at https://www.plantbaseddrjules.com/shop

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Dr. Jules

Chapters

• 0:00 Section A

Transcript

Speaker 1: 0:10

Hey everyone, welcome to Season 2 of the Dr Jules Plant-Based Podcast, where we discuss everything from plant-based nutrition to the main pillars of lifestyle medicine. Yo, plant-based buddies, welcome back to another episode of the podcast. Today we're going to be answering a very common question Should you go for routine blood work? Is there any specific blood work to be done if you're going on a plant-based diet? What about metabolic health? What about nutrient deficiencies? Should we be testing these things before, during or after changing our lifestyle? And if so, at what frequency? So the simple question should we be ordering blood tests? Seems simple, but the truth is is that the answer is a lot more nuanced than just yes or no. So today we'll talk about why nutrient deficiencies can be so sneaky, how they show up differently in different people, how some take more time to appear on a routine blood test, and why blood testing is not the greatest way to screen for all of them. So grab your coffee or green smoothie and let's dive into it Now.

Speaker 1: 1:35

Certain nutrient deficiencies are actually quite tricky to spot, and one of the challenges of these deficiencies is that they take a long time to appear when it comes to certain specific nutrients. Now take calcium, for example. The vast majority of calcium is stored inside of your bones, so you could go decades without having low blood calcium levels. Even if your diet is deficient in calcium, your body is simply going to quietly pull calcium and leach calcium for your bones just to keep blood levels stable. Stable levels of calcium are required for muscle contraction, for blood clotting and for heart function. By the time you see a calcium deficiency on blood work so by the time you see a calcium deficiency on blood work you probably already have osteoporosis, and typically that doesn't show up until you're at least age 50.

Speaker 1: 2:40

Stop getting it in your diet. It could take three, six months, sometimes even up to 12 months, before you start feeling even just mild symptoms Maybe a bit of fatigue or brain fog and those symptoms can creep up very slowly. Now, iron can be quite different. Sometimes you'll feel it within weeks. Shortness of breath, fatigue. Maybe your exercise routine is starting to feel harder than usual. But even then these symptoms can be missed because they're very non-specific and can be explained by a million other things like poor sleep or perimenopause. But that's the big problem. Fatigue, brain fog, low mood. These symptoms can come from dozens of causes, not just nutrition or nutrient deficiencies.

Speaker 1: 3:36

As a doctor, I have to look at the whole picture before I can decide whether or not you should get blood tests and, if you do, before I can decide whether or not you should get blood tests and, if you do, which ones are pertinent. Often I'll get this one patient that says I want you to check for everything, let's just check everything in my blood. I want a VIP nutrient panel and as much as I'd love to snap my fingers and give every patient a full VIP blood workup, that's just not realistic. First of all, there's the concept of incidental findings. When you look for things that aren't important, you find things and then you need to explore these things. A liver profile a blood test that checks liver inflammation, liver enzymes, liver profile a blood test that checks liver inflammation, liver enzymes, liver function is the perfect example of if we just throw it onto every single blood panel we order, we're going to get a lot of false positives. Now, these positive tests that signal either liver inflammation or liver dysfunction might end up being something severe that we just just so happen to find, incidentally, but most of the time, these tests will lead you down a path of retesting and liver imaging and ultrasounds, only to find something that you knew was already there, like bad liver, for example. Or basically you go down that rabbit hole of exploring why liver tests are not normal, just to find out that the patient had influenza the week before or binge drank alcohol all weekend.

Speaker 1: 5:22

We also have to think about resources. Look in Canada and in New Brunswick, where I practice medicine, our healthcare system is publicly funded, so that's great and that's meaning we get free healthcare for the most part, but it also means that we have to prioritize how we use those finite resources. As a doctor, I'm there to protect my patient, but I'm also there to protect my healthcare system, and during the pandemic here in New Brunswick, there was a point where only urgent blood tests were being run because there weren't enough lab staff to keep up to the demand. Same thing goes for MRIs. If we're ordering MRIs for everyone, well then, the patients who needed the most are waiting months to get a very important test. As I said, another reason is that we could end up finding tiny fluctuations that aren't really clinically significant, but still to make sure we're not missing anything, we unnecessarily order further testing that could lead to biopsies, or imaging leads to a whole plethora of testing that's not really needed, so instead it's best to take a stepwise approach.

Speaker 1: 6:42

Start with a detailed medical history, a dietary history. You'll look for patterns and then, if something doesn't add up or if there's a clear risk factor, that's when you should be ordering targeted personalized testing, not all the tests, all the tests. One of the best ways to decide if blood work makes sense for you is to see if you fall into any high-risk group. For example, if you're pregnant or you're breastfeeding, your need for iron goes way up. If you're on certain medications like metformin for diabetes or regular antacids, then your risk for B12 deficiency is higher, as it would be for anyone who is on a plant-predominant diet, but not supplementing. A family history also matters. For example, celiac disease will run in families and one of the ways that it's sometimes picked up is through nutrient deficiencies like iron, for example. And of course, diet plays a huge role in all of these. Be mindful of B12 on plant-based diets, but, on the other hand, be mindful of other nutrients if you're on other restrictive diets, like a keto diet or a paleo diet or a carnivore diet.

Speaker 1: 8:07

Sometimes it's not even about the whole dietary pattern. It's about avoiding specific food groups. Maybe you don't eat legumes because of digestive discomfort and bloating, or you skip nuts and seeds for allergies and over time, that could put you at risk for certain specific deficiencies related to restricting that specific food group. Now this is where you need to be having an honest, detailed conversation with your doctor or with your registered dietitian, and if you really want to help us, you should even consider logging in your food intake for maybe a week or two. That could be really helpful. Now, if it's a little bit complicated writing everything down on a piece of paper, consider downloading apps like Cronometer paper. Consider downloading apps like Cronometer, where you can scan barcodes or simply enter the portions of foods that you're eating, and this will detail any micronutrient deficiencies that you may have.

Speaker 1: 9:11

Now, as a doctor, it's also my responsibility to spot patterns and symptoms. So, even though most nutrient deficiencies have very vague symptoms that are non-specific, sometimes these patterns can still be a clue, like, for example, iron deficiency might look like fatigue, feeling more short of breath during workouts or even shortness of breath during everyday activities. B12 deficiency can cause a whole bunch of symptoms like tingling in your hands and your feet or balance issues or even memory problems. The more specific the symptom cluster, the easier it's going to be for me to target the right test. Now. A lot of patients have already done their research. They come in and ask for specific screenings, but I just want to make sure that my patients are consulting credible resources online before they jump to conclusions.

Speaker 1: 10:15

Now, before doing any blood work, there are a ton of different tools that could be useful from a tracking perspective. Now, the Canadian Food Guide or things like Dr Greger's Daily Dozen Checklist are great ways to see if you're consistently missing certain food groups. There are also free apps you can download on your smartphone, like Cronometer, that could give you an estimate of your nutrient intake. Just remember, they don't account for absorption issues, so they're just tracking what you're putting in your mouth, not what you're absorbing. You could theoretically be eating plenty of zinc, but if you're eating a lot of phytates from certain food groups, like grains or beans, maybe your body's not absorbing all of that zinc. Now keep in mind that if you're eating enough zinc, the absorption that will be reduced by phytase is probably negligible and you're still getting enough zinc to meet your needs. But in those people that are eating low amounts, unhealthy diets that are not well planned, then maybe these phytase could play a role.

Speaker 1: 11:35

Now just a quick note about food tracking or food logging. It's not for everyone. For some people it can actually trigger unhealthy relationships with food and for some people it'll go as far as triggering patterns of disordered eating. So use these tools wisely and, just like blood work, food logging is just one tool amongst many. So the takeaway here is that if you and your doctor decide that testing is worthwhile these are the basics that I often start with A complete blood count That'll look at your red blood cells, your white blood cells, your platelets and, if ever you are deficient in B12, in folate, or you're taking heavy metals or you have inflammation or infections, you could see shifts in the numbers of white blood cells and red blood cells.

Speaker 1: 12:38

You could see your red blood cells get smaller with iron deficiency or bigger in B12 deficiency. I'd also order a metabolic profile so that'll look at how you're metabolizing energy, sugar, cholesterol. I'd look at your kidney function, at your liver function, at HbA1c, which will indicate a three-month blood sugar average. We'll look at your cholesterol and ApoB. We'll look at certain specific nutrients like iron, b12, and vitamin D if you're considered to be at higher risk for deficiencies, but certain tests are not really worth checking. Specific minerals like zinc or calcium aren't always that useful in blood work because your body works hard to keep those blood levels stable even if your stores are low. Other tests, like thyroid function, will depend on your symptoms, on your history.

Speaker 1: 13:42

But if you're transitioning specifically to a plant-based diet, I think it's very reasonable to order certain baseline blood tests before you start and again three to six months later. Now it's motivating to see metabolic improvements in your numbers. It's also safe to say that you're likely transitioning towards a plant-based diet to be healthier. So seeing your cholesterol improve or insulin resistance go down are things that typically are very motivating for patients. Now also keep in mind that certain deficiencies can take time to appear. So, for example, if you do a B12 test at the beginning of your plant-based transition and you check it again in six months and it's still normal that doesn't mean you don't need to supplement. It could take maybe six months to a year before deficiencies in B12 start to appear. Year before deficiencies in B12 start to appear.

Speaker 1: 14:43

So make sure that, regardless of what your blood levels say, I'd say vitamin B12 supplementation is a non-negotiable. You should be taking vitamin B12 regardless of what your blood test is saying. So again, should we be ordering blood tests, yes or no? The answer is it depends. Testing will make most sense when there are clear risk factors, specific symptoms or big dietary changes. The more information you can give to your doctor about your diet, about your symptoms, your family history, your medical history, the better we can decide which tests are worth doing.

Speaker 1: 15:26

Now remember the ultimate goal isn't just to find deficiencies after the fact, it's to prevent them in the first place, and that means eating a variety of nutrient-rich foods, moving your body, managing stress. Nutrient-rich foods, moving your body, managing stress, sleeping well and building a lifestyle that supports your health from all angles. Now, if you're considering a plant-based diet, do it with intention, plan it, aim for variety and don't be afraid to check in with your healthcare team along the way. Probably you would benefit from getting blood work. We just want to make sure to not overdo it, because the risk is to find things that are not clinically relevant. That would lead us towards a rabbit hole of further testing and further imaging. That creates stress, and sometimes these interventions can lead to complications Right on.

Speaker 1: 16:29

So that's the episode for today. Moral of the story it's reasonable to do blood work. We don't want to over-test and we don't want to be ordering wide blood test panel on everyone. We'll be finding things that are not relevant. That will create stress. We'll be taxing our healthcare system. Best way of measuring nutrient adequacy in your diet is tracking your diet and not just drawing blood right on. Hope this episode served you well. Talk to your doctor on whether or not you should be doing testing for you, and thanks for listening. We'll see you in the next episode, peace, hey, everyone, go check out my website plantbaseddrjulescom to find free downloadable resources and remember that you can find me on facebook and instagram at drjulescormier, and on youtube at plantbaseddrjules.