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

Don't forget to check out my blog at https://www.plantbaseddrjules.com/blog

You can also watch my educational videos on YouTube at https://www.youtube.com/channel/UCMpkQRXb7G-StAotV0dmahQ

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Thanks so much!

Peace, love, plants!
Dr. Jules

Episode Transcript

Speaker 1 (00:10):
Hey everyone, welcome to Season 2 of the Dr Jules
Plant-Based Podcast, where wediscuss everything from
plant-based nutrition to themain pillars of lifestyle
medicine.
Yo, plant-based buddies,welcome back to another episode
of the podcast.
Today we're going to beanswering a very common question

(00:30):
Should you go for routine bloodwork?
Is there any specific bloodwork to be done if you're going
on a plant-based diet?
What about metabolic health?
What about nutrientdeficiencies?
Should we be testing thesethings before, during or after
changing our lifestyle?
And if so, at what frequency?

(00:51):
So the simple question shouldwe be ordering blood tests?
Seems simple, but the truth isis that the answer is a lot more
nuanced than just yes or no.
So today we'll talk about whynutrient deficiencies can be so
sneaky, how they show updifferently in different people,
how some take more time toappear on a routine blood test,

(01:17):
and why blood testing is not thegreatest way to screen for all
of them.
So grab your coffee or greensmoothie and let's dive into it
Now.
Certain nutrient deficienciesare actually quite tricky to

(01:37):
spot, and one of the challengesof these deficiencies is that
they take a long time to appearwhen it comes to certain
specific nutrients.
Now take calcium, for example.
The vast majority of calcium isstored inside of your bones, so
you could go decades withouthaving low blood calcium levels.
Even if your diet is deficientin calcium, your body is simply

(02:02):
going to quietly pull calciumand leach calcium for your bones
just to keep blood levelsstable.
Stable levels of calcium arerequired for muscle contraction,
for blood clotting and forheart function.
By the time you see a calciumdeficiency on blood work so by

(02:34):
the time you see a calciumdeficiency on blood work you
probably already haveosteoporosis, and typically that
doesn't show up until you're atleast age 50.
Stop getting it in your diet.
It could take three, six months, sometimes even up to 12 months
, before you start feeling evenjust mild symptoms Maybe a bit
of fatigue or brain fog andthose symptoms can creep up very

(02:56):
slowly.
Now, iron can be quitedifferent.
Sometimes you'll feel it withinweeks.
Shortness of breath, fatigue.
Maybe your exercise routine isstarting to feel harder than
usual.
But even then these symptomscan be missed because they're
very non-specific and can beexplained by a million other

(03:18):
things like poor sleep orperimenopause.
But that's the big problem.
Fatigue, brain fog, low mood.
These symptoms can come fromdozens of causes, not just
nutrition or nutrientdeficiencies.
As a doctor, I have to look atthe whole picture before I can

(03:41):
decide whether or not you shouldget blood tests and, if you do,
before I can decide whether ornot you should get blood tests
and, if you do, which ones arepertinent.
Often I'll get this one patientthat says I want you to check
for everything, let's just checkeverything in my blood.
I want a VIP nutrient panel andas much as I'd love to snap my

(04:01):
fingers and give every patient afull VIP blood workup, that's
just not realistic.
First of all, there's theconcept of incidental findings.
When you look for things thataren't important, you find
things and then you need toexplore these things.
A liver profile a blood testthat checks liver inflammation,

(04:24):
liver enzymes, liver profile ablood test that checks liver
inflammation, liver enzymes,liver function is the perfect
example of if we just throw itonto every single blood panel we
order, we're going to get a lotof false positives.
Now, these positive tests thatsignal either liver inflammation
or liver dysfunction might endup being something severe that

(04:47):
we just just so happen to find,incidentally, but most of the
time, these tests will lead youdown a path of retesting and
liver imaging and ultrasounds,only to find something that you
knew was already there, like badliver, for example.
Or basically you go down thatrabbit hole of exploring why

(05:10):
liver tests are not normal, justto find out that the patient
had influenza the week before orbinge drank alcohol all weekend
.
We also have to think aboutresources.
Look in Canada and in NewBrunswick, where I practice
medicine, our healthcare systemis publicly funded, so that's

(05:32):
great and that's meaning we getfree healthcare for the most
part, but it also means that wehave to prioritize how we use
those finite resources.
As a doctor, I'm there toprotect my patient, but I'm also
there to protect my healthcaresystem, and during the pandemic
here in New Brunswick, there wasa point where only urgent blood

(05:53):
tests were being run becausethere weren't enough lab staff
to keep up to the demand.
Same thing goes for MRIs.
If we're ordering MRIs foreveryone, well then, the
patients who needed the most arewaiting months to get a very
important test.
As I said, another reason isthat we could end up finding

(06:18):
tiny fluctuations that aren'treally clinically significant,
but still to make sure we're notmissing anything, we
unnecessarily order furthertesting that could lead to
biopsies, or imaging leads to awhole plethora of testing that's
not really needed, so insteadit's best to take a stepwise

(06:41):
approach.
Start with a detailed medicalhistory, a dietary history.
You'll look for patterns andthen, if something doesn't add
up or if there's a clear riskfactor, that's when you should
be ordering targetedpersonalized testing, not all
the tests, all the tests.

(07:09):
One of the best ways to decideif blood work makes sense for
you is to see if you fall intoany high-risk group.
For example, if you're pregnantor you're breastfeeding, your
need for iron goes way up.
If you're on certainmedications like metformin for
diabetes or regular antacids,then your risk for B12
deficiency is higher, as itwould be for anyone who is on a

(07:31):
plant-predominant diet, but notsupplementing.
A family history also matters.
For example, celiac diseasewill run in families and one of
the ways that it's sometimespicked up is through nutrient
deficiencies like iron, forexample.
And of course, diet plays ahuge role in all of these.

(07:51):
Be mindful of B12 onplant-based diets, but, on the
other hand, be mindful of othernutrients if you're on other
restrictive diets, like a ketodiet or a paleo diet or a
carnivore diet.
Sometimes it's not even aboutthe whole dietary pattern.
It's about avoiding specificfood groups.

(08:13):
Maybe you don't eat legumesbecause of digestive discomfort
and bloating, or you skip nutsand seeds for allergies and over
time, that could put you atrisk for certain specific
deficiencies related torestricting that specific food
group.
Now this is where you need tobe having an honest, detailed

(08:36):
conversation with your doctor orwith your registered dietitian,
and if you really want to helpus, you should even consider
logging in your food intake formaybe a week or two.
That could be really helpful.
Now, if it's a little bitcomplicated writing everything
down on a piece of paper,consider downloading apps like

(08:57):
Cronometer paper.
Consider downloading apps likeCronometer, where you can scan
barcodes or simply enter theportions of foods that you're
eating, and this will detail anymicronutrient deficiencies that
you may have.
Now, as a doctor, it's also myresponsibility to spot patterns
and symptoms.
So, even though most nutrientdeficiencies have very vague

(09:22):
symptoms that are non-specific,sometimes these patterns can
still be a clue, like, forexample, iron deficiency might
look like fatigue, feeling moreshort of breath during workouts
or even shortness of breathduring everyday activities.
B12 deficiency can cause awhole bunch of symptoms like

(09:44):
tingling in your hands and yourfeet or balance issues or even
memory problems.
The more specific the symptomcluster, the easier it's going
to be for me to target the righttest.
Now.
A lot of patients have alreadydone their research.
They come in and ask forspecific screenings, but I just

(10:06):
want to make sure that mypatients are consulting credible
resources online before theyjump to conclusions.
Now, before doing any blood work, there are a ton of different
tools that could be useful froma tracking perspective.
Now, the Canadian Food Guide orthings like Dr Greger's Daily

(10:30):
Dozen Checklist are great waysto see if you're consistently
missing certain food groups.
There are also free apps youcan download on your smartphone,
like Cronometer, that couldgive you an estimate of your
nutrient intake.
Just remember, they don'taccount for absorption issues,
so they're just tracking whatyou're putting in your mouth,

(10:51):
not what you're absorbing.
You could theoretically beeating plenty of zinc, but if
you're eating a lot of phytatesfrom certain food groups, like
grains or beans, maybe yourbody's not absorbing all of that
zinc.
Now keep in mind that if you'reeating enough zinc, the

(11:14):
absorption that will be reducedby phytase is probably
negligible and you're stillgetting enough zinc to meet your
needs.
But in those people that areeating low amounts, unhealthy
diets that are not well planned,then maybe these phytase could
play a role.

(11:35):
Now just a quick note about foodtracking or food logging.
It's not for everyone.
For some people it can actuallytrigger unhealthy relationships
with food and for some peopleit'll go as far as triggering
patterns of disordered eating.
So use these tools wisely and,just like blood work, food

(11:57):
logging is just one tool amongstmany.
So the takeaway here is that ifyou and your doctor decide that
testing is worthwhile these arethe basics that I often start
with A complete blood countThat'll look at your red blood
cells, your white blood cells,your platelets and, if ever you

(12:21):
are deficient in B12, in folate,or you're taking heavy metals
or you have inflammation orinfections, you could see shifts
in the numbers of white bloodcells and red blood cells.
You could see your red bloodcells get smaller with iron
deficiency or bigger in B12deficiency.

(12:45):
I'd also order a metabolicprofile so that'll look at how
you're metabolizing energy,sugar, cholesterol.
I'd look at your kidneyfunction, at your liver function
, at HbA1c, which will indicatea three-month blood sugar
average.
We'll look at your cholesteroland ApoB.

(13:06):
We'll look at certain specificnutrients like iron, b12, and
vitamin D if you're consideredto be at higher risk for
deficiencies, but certain testsare not really worth checking.
Specific minerals like zinc orcalcium aren't always that

(13:27):
useful in blood work becauseyour body works hard to keep
those blood levels stable evenif your stores are low.
Other tests, like thyroidfunction, will depend on your
symptoms, on your history.
But if you're transitioningspecifically to a plant-based
diet, I think it's veryreasonable to order certain

(13:48):
baseline blood tests before youstart and again three to six
months later.
Now it's motivating to seemetabolic improvements in your
numbers.
It's also safe to say thatyou're likely transitioning
towards a plant-based diet to behealthier.
So seeing your cholesterolimprove or insulin resistance go

(14:09):
down are things that typicallyare very motivating for patients
.
Now also keep in mind thatcertain deficiencies can take
time to appear.
So, for example, if you do aB12 test at the beginning of
your plant-based transition andyou check it again in six months
and it's still normal thatdoesn't mean you don't need to

(14:32):
supplement.
It could take maybe six monthsto a year before deficiencies in
B12 start to appear.
Year before deficiencies in B12start to appear.
So make sure that, regardless ofwhat your blood levels say, I'd
say vitamin B12 supplementationis a non-negotiable.
You should be taking vitaminB12 regardless of what your

(14:52):
blood test is saying.
So again, should we be orderingblood tests, yes or no?
The answer is it depends.
Testing will make most sensewhen there are clear risk
factors, specific symptoms orbig dietary changes.
The more information you cangive to your doctor about your

(15:15):
diet, about your symptoms, yourfamily history, your medical
history, the better we candecide which tests are worth
doing.
Now remember the ultimate goalisn't just to find deficiencies
after the fact, it's to preventthem in the first place, and
that means eating a variety ofnutrient-rich foods, moving your

(15:38):
body, managing stress.
Nutrient-rich foods, movingyour body, managing stress,
sleeping well and building alifestyle that supports your
health from all angles.
Now, if you're considering aplant-based diet, do it with
intention, plan it, aim forvariety and don't be afraid to
check in with your healthcareteam along the way.

(15:58):
Probably you would benefit fromgetting blood work.
We just want to make sure tonot overdo it, because the risk
is to find things that are notclinically relevant.
That would lead us towards arabbit hole of further testing
and further imaging.
That creates stress, andsometimes these interventions

(16:23):
can lead to complications Righton.
So that's the episode for today.
Moral of the story it'sreasonable to do blood work.
We don't want to over-test andwe don't want to be ordering
wide blood test panel oneveryone.

(16:44):
We'll be finding things thatare not relevant.
That will create stress.
We'll be taxing our healthcaresystem.
Best way of measuring nutrientadequacy in your diet is
tracking your diet and not justdrawing blood right on.
Hope this episode served youwell.

(17:06):
Talk to your doctor on whetheror not you should be doing
testing for you, and thanks forlistening.
We'll see you in the nextepisode, peace, hey, everyone,

(17:29):
go check out my websiteplantbaseddrjulescom to find
free downloadable resources andremember that you can find me on
facebook and instagram atdrjulescormier, and on youtube
at plantbaseddrjules.