As an integrative psychiatrist, Dr. Massoumi orders the following serum levels in many of her patients:
- Vitamin B12 level
- Vitamin D level--specifically 25-hydroxyvitamin D (not 1,25-di-hydroxyvitamin D)
- Ferritin level (level of storage iron)
- RBC magnesium level (intracellular magnesium)
- RBC zinc level (intracellular zinc)
Based on the lab results, here are some of her suggestions:
- Vitamin B12: To avoid overt peripheral neuropathy or dementia, staying above 200 picogram/milliliter (pg/mL) is standard practice. But some preliminary studies endorse keeping B12 levels above 500 pg/mL in order to protect against dementia.
- Vitamin D: For general health, a level of vitamin D above 30 ng/mL is generally considered normal, but integrative practitioners shoot for levels of at least 50 ng/mL.
- Magnesium: Mg is the best natural supplement for the treatment and prevention of headaches, including migraine headaches. Approximately 40% of Americans are deficient in magnesium. Shoot for RBC magnesium level in the upper half of normal, or >5 mg/dL.
- Iron: Low iron levels are one of the nutritional deficiencies that can cause restless leg syndrome. Keep ferritin levels above 30 ng/mL.
- Zinc: Zinc supplementation has been shown to (modestly) reduce hyperactivity and impulsivity. If the zinc is in the lower half of normal (with a typical lab's normal range being 9-15 mg/L), prescribe a zinc supplement.
Hopefully you find this helpful! Let us know if you have any thoughts.
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Daniel J. Carlat, MD