Diagnostics & Optimization
VITAMIN D & KEY MICRONUTRIENTS
The most expensive supplement stack in the world is worthless if you're correcting the wrong deficiencies. Micronutrient testing reveals the hidden bottlenecks silently undermining your hormones, energy, immune function, and metabolism.
WHY DEFICIENCIES ARE EPIDEMIC IN WELL-FED POPULATIONS
Americans eat more calories than any population in human history and are simultaneously among the most micronutrient-depleted. This is not a paradox. It is the predictable result of how modern food is grown, processed, and consumed.
Industrial agriculture prioritizes yield per acre, not nutrient density per calorie. A landmark study published in the Journal of the American College of Nutrition (Davis et al., 2004) compared USDA nutrient data from 1950 to 1999 and found statistically significant declines in protein, calcium, phosphorus, iron, riboflavin, and vitamin C across 43 garden crops. The soil is depleted. The crops reflect it. And that's before processing strips what little remains.
On top of that, several modern realities compound the problem:
Soil Depletion
Mineral content in agricultural soil has declined 20-40% over the past 50 years due to monocropping, synthetic fertilizers (which replenish NPK but not trace minerals), and erosion. Selenium, zinc, magnesium, and iron in crops track directly with soil content. The food looks the same. It is not the same.
Food Processing
Refining wheat into white flour removes approximately 80% of the magnesium, 70% of the zinc, and 85% of the vitamin B6. Ultra-processed foods now account for over 60% of calories consumed in America (Martínez Steele et al., 2016, BMJ Open). These foods are calorie-dense and micronutrient-poor by design.
Indoor Living & Sunscreen
Humans evolved making vitamin D from UVB sunlight exposure. Modern life means most people spend 90%+ of their time indoors. When they do go outside, sunscreen blocks UVB-mediated vitamin D synthesis. Geographic latitude matters too — anyone living above the 37th parallel (roughly a line from San Francisco to Richmond, Virginia) cannot produce meaningful vitamin D from sunlight for 4-6 months of the year.
Medications That Deplete
Metformin depletes B12. Proton pump inhibitors (PPIs) deplete magnesium, B12, and iron absorption. Oral contraceptives deplete B6, B12, folate, magnesium, and zinc. Statins deplete CoQ10. Diuretics deplete magnesium and potassium. These are among the most commonly prescribed drugs in America, and nutrient depletion is rarely monitored.
Increased Demand
Chronic stress increases magnesium excretion. Exercise increases zinc, iron, and magnesium requirements. Pregnancy dramatically increases demand for iron, folate, and vitamin D. The RDA was designed for preventing frank deficiency diseases in sedentary populations — not for supporting performance, recovery, or optimal hormonal function.
Gut Dysfunction
You don't absorb what you eat — you absorb what you digest and transport across an intact intestinal lining. Gut inflammation, dysbiosis, low stomach acid, celiac disease, and SIBO all impair micronutrient absorption regardless of dietary intake. This is why some patients remain deficient despite supplementing.
The takeaway: Eating a "healthy diet" is necessary but frequently insufficient. The food supply has changed. Lifestyle demands have increased. And the RDA was designed to prevent scurvy and rickets, not to optimize hormone production, immune function, or cognitive performance. Testing is the only way to know what your body actually has versus what it needs.
VITAMIN D: THE MOST IMPORTANT NUTRIENT MOST PEOPLE ARE MISSING
Vitamin D is misnamed. It is not a vitamin — it is a prohormone. Your body synthesizes it from cholesterol when UVB radiation hits the skin, converts it to 25-hydroxyvitamin D (25-OH D) in the liver, and then to the active form 1,25-dihydroxyvitamin D (calcitriol) in the kidneys and other tissues. Calcitriol functions as a steroid hormone, binding to vitamin D receptors (VDR) present in virtually every cell in the body. This is why its effects are so far-reaching.
The numbers are staggering. An estimated 42% of American adults are vitamin D deficient (<20 ng/mL), and over 70% are below the optimal threshold of 50 ng/mL (Forrest & Stuhldreher, 2011, Nutrition Research). Darker-skinned individuals, those living at northern latitudes, the obese, and the elderly are at even higher risk. This is arguably the single most prevalent nutritional deficiency in the developed world.
Immune Function
Vitamin D activates antimicrobial peptides (cathelicidin, defensins) in innate immunity and modulates adaptive immune responses. Deficiency is associated with increased susceptibility to respiratory infections, autoimmune diseases, and impaired vaccine response. A meta-analysis by Martineau et al. (2017) in the BMJ involving over 11,000 participants found that vitamin D supplementation reduced the risk of acute respiratory tract infections, with the greatest benefit in those who were most deficient.
Testosterone & Hormone Production
Vitamin D receptors are present in Leydig cells (the cells that produce testosterone). A randomized controlled trial by Pilz et al. (2011) in Hormone and Metabolic Research found that men supplementing with vitamin D for one year had significantly higher testosterone levels compared to placebo. Vitamin D also influences SHBG levels and estrogen metabolism. In the context of hormone optimization, correcting vitamin D deficiency is a prerequisite, not an afterthought.
Bone Density & Calcium Metabolism
This is the function most people know about, and it is real. Vitamin D regulates calcium absorption from the gut and calcium/phosphorus homeostasis in bone. Without adequate vitamin D, you absorb only 10-15% of dietary calcium (versus 30-40% when vitamin D is sufficient). Long-term deficiency leads to osteomalacia in adults and rickets in children. But framing vitamin D as a "bone vitamin" dramatically understates its importance.
Mood, Cognition & Insulin Sensitivity
Vitamin D receptors are densely concentrated in the hippocampus and prefrontal cortex. Deficiency is associated with increased risk of depression (Anglin et al., 2013, British Journal of Psychiatry), cognitive decline, and Alzheimer's disease. Vitamin D also improves insulin sensitivity by upregulating insulin receptor expression and modulating inflammatory cytokines. Low vitamin D is independently associated with increased risk of type 2 diabetes.
Cancer Risk Reduction
Observational data consistently shows that higher vitamin D levels are associated with reduced risk of colorectal, breast, and prostate cancers. A pooled analysis by Garland et al. (2006) in the American Journal of Public Health estimated that maintaining 25-OH D levels above 52 ng/mL was associated with a 50% reduction in colorectal cancer incidence. The VITAL trial (Manson et al., 2019, NEJM) showed a reduction in cancer mortality with vitamin D supplementation, though not overall cancer incidence. The mechanism: vitamin D regulates cell differentiation, apoptosis, and angiogenesis.
| 25-OH Vitamin D Level | Classification |
|---|---|
| < 20 ng/mL | Deficient |
| 20 – 29 ng/mL | Insufficient |
| 30 – 49 ng/mL | Adequate (conventional), Suboptimal (functional) |
| 50 – 80 ng/mL | Optimal |
| > 100 ng/mL | Potentially toxic (monitor calcium) |
Dosing and cofactors: Most adults need 4,000-5,000 IU of vitamin D3 per day to reach and maintain optimal levels. Obese individuals may need 6,000-10,000 IU due to sequestration in adipose tissue. Vitamin D should always be taken with vitamin K2 (MK-7 form, 100-200 mcg/day) to direct calcium into bones and out of arteries, and with magnesium, which is required for vitamin D activation and metabolism. Test: 25-OH vitamin D. Recheck 8-12 weeks after starting supplementation.
MAGNESIUM & IRON: THE TWO MOST UNDER-TESTED DEFICIENCIES
If vitamin D is the most common deficiency, magnesium and iron are the most consequential ones that standard medicine fails to test properly. Both are involved in hundreds of biochemical processes, both are chronically under-consumed, and both are assessed with the wrong lab tests by most practitioners.
MAGNESIUM
Magnesium is a cofactor in over 300 enzymatic reactions, including ATP production, DNA synthesis, protein synthesis, neurotransmitter release, and muscle contraction. It is required for the activation of vitamin D and for proper thyroid hormone conversion (T4 to T3). Despite its central role in human physiology, the USDA estimates that over 50% of Americans consume less than the estimated average requirement for magnesium.
The standard test — serum magnesium — is almost useless for detecting deficiency. Less than 1% of total body magnesium resides in serum. The body tightly regulates serum magnesium by pulling from bone and tissue stores, meaning serum levels stay "normal" until stores are severely depleted. RBC magnesium is the better test — it reflects intracellular magnesium status and catches depletion much earlier. Optimal RBC magnesium: 5.0-6.5 mg/dL.
Glycinate
Best for sleep, anxiety, and general repletion. Glycine has independent calming effects on the nervous system. Well-absorbed, minimal GI side effects.
Threonate (Magtein)
The only form shown to effectively cross the blood-brain barrier. Best for cognitive function, memory, and neuroprotection. Backed by preclinical data from MIT (Bhatt et al., 2020).
Taurate
Preferred for cardiovascular support. Taurine independently supports blood pressure regulation, cardiac rhythm stability, and endothelial function.
Symptoms of magnesium depletion: insomnia, muscle cramps, anxiety, headaches, elevated blood pressure, heart palpitations, constipation, poor exercise recovery, and impaired insulin sensitivity. Many of these get treated with separate medications when the root cause is a $15/month mineral.
IRON & FERRITIN
Iron is essential for oxygen transport (hemoglobin), energy production (mitochondrial cytochromes), thyroid hormone conversion, neurotransmitter synthesis, and DNA replication. Ferritin is the storage form of iron — your body's iron reserve. And ferritin is where most deficiency hides, undetected.
Here is the problem: most doctors check a CBC (hemoglobin, hematocrit) and call it done. Hemoglobin drops only after iron stores are completely exhausted — it is the last domino to fall. A patient can have a hemoglobin of 12.5 g/dL (technically "normal") and a ferritin of 12 ng/mL (functionally depleted). That patient will have fatigue, hair loss, brain fog, cold intolerance, poor exercise tolerance, and impaired thyroid function — and be told everything is fine.
| Ferritin Level | Status |
|---|---|
| < 30 ng/mL | Depleted (iron deficiency regardless of hemoglobin) |
| 30 – 50 ng/mL | Suboptimal (symptomatic in many patients) |
| 50 – 150 ng/mL (women) | Optimal |
| 75 – 150 ng/mL (men) | Optimal |
| > 200 ng/mL | Elevated (investigate: inflammation, hemochromatosis) |
Who is most at risk: Menstruating women (monthly blood loss), athletes (exercise-induced hemolysis and GI iron loss), vegetarians/vegans (non-heme iron is poorly absorbed), anyone on PPIs (acid is required for iron absorption), and patients with gut inflammation or celiac disease. Iron is also a critical cofactor for the 5'-deiodinase enzyme that converts thyroid T4 to active T3 — meaning iron deficiency can directly cause functional hypothyroidism.
B12, ZINC & SELENIUM: THE OVERLOOKED TRIAD
These three micronutrients don't get the attention of vitamin D or iron, but they are quietly involved in some of the most critical biochemical processes in the body — from testosterone production to thyroid conversion to methylation and detoxification. Deficiency in any one of them can stall optimization even when everything else looks good on paper.
Vitamin B12 (Cobalamin)
B12 is essential for red blood cell formation, neurological function, DNA synthesis, and methylation — the process by which your body activates and deactivates genes, processes hormones, and detoxifies metabolic waste. Deficiency causes fatigue, peripheral neuropathy (numbness, tingling), cognitive impairment, depression, and macrocytic anemia. Populations at highest risk: vegetarians and vegans (B12 is found almost exclusively in animal products), adults over 50 (decreased intrinsic factor and stomach acid), metformin users (metformin impairs B12 absorption in the ileum — prevalence of deficiency in long-term metformin users is 10-30%), and anyone on PPIs. The standard serum B12 test is a poor screening tool — levels can be "normal" while functional B12 status is inadequate. Methylmalonic acid (MMA) is a more sensitive and specific marker. An elevated MMA with a "normal" serum B12 confirms functional deficiency. Optimal serum B12: above 500 pg/mL (not just above 200).
Zinc
Zinc is a cofactor in over 100 enzymatic reactions and is critical for testosterone production, immune function, wound healing, thyroid conversion (T4 to T3), taste and smell, and gene expression. Zinc is required for the function of the enzyme 5-alpha reductase and for Leydig cell testosterone synthesis — making it foundational for male hormone optimization. In women, zinc deficiency is associated with menstrual irregularity and impaired follicular development. Zinc also supports immune function: even mild deficiency impairs T-cell and natural killer cell activity. The challenge: zinc competes with copper for absorption, so supplementing zinc without monitoring copper can create a secondary deficiency. Optimal serum zinc: 90-120 mcg/dL. Dose: 30-50 mg/day of zinc picolinate or zinc bisglycinate (highly bioavailable forms). Always balance with 1-2 mg copper if supplementing above 30 mg/day long-term.
Selenium
Selenium is a trace mineral that most people have never thought about, yet it is essential for two of the most important enzyme systems in the body. First: the 5'-deiodinase enzymes that convert thyroid T4 to active T3 are selenoproteins — meaning they literally cannot function without selenium. Second: glutathione peroxidase, your body's primary intracellular antioxidant enzyme, is selenium-dependent. Without adequate selenium, you cannot convert thyroid hormone efficiently and you cannot neutralize oxidative stress effectively. Selenium is also critical for thyroid autoimmunity — a meta-analysis by Wichman et al. (2016, Thyroid) found that selenium supplementation significantly reduced TPO antibody levels in patients with Hashimoto's thyroiditis. Optimal dose: 200 mcg/day of selenomethionine. Selenium has a narrow therapeutic window — doses above 400 mcg/day risk toxicity (selenosis). More is not better.
The interconnection matters: These nutrients don't work in isolation. Zinc and selenium are both required for thyroid T4-to-T3 conversion. B12 and zinc are both required for proper methylation. Iron and B12 are both required for red blood cell production. Correcting one deficiency while ignoring the others is like fixing one flat tire on a car with four. This is why a comprehensive panel — not individual spot-checks — is the only way to identify and resolve the actual bottleneck.
OMEGA-3 FATTY ACIDS: THE ANTI-INFLAMMATORY FOUNDATION
Omega-3 fatty acids — specifically EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) — are not just another supplement trend. They are structural components of every cell membrane in your body and precursors to resolvins and protectins, the molecules your body uses to resolve inflammation. The typical American diet delivers an omega-6 to omega-3 ratio of approximately 15:1 to 20:1. The evolutionary ratio: closer to 2:1. This imbalance drives chronic, low-grade systemic inflammation — the underlying substrate of cardiovascular disease, neurodegeneration, metabolic dysfunction, and autoimmunity.
DHA makes up approximately 40% of the polyunsaturated fatty acids in the brain and 60% of the fatty acids in the retina. It is neuroprotective, supporting synaptic plasticity, neurogenesis, and cognitive function across the lifespan. EPA is the more potent anti-inflammatory of the two, inhibiting pro-inflammatory eicosanoid synthesis and reducing CRP, IL-6, and TNF-alpha.
Cardiovascular benefits are well-established. The REDUCE-IT trial (Bhatt et al., 2019, NEJM) demonstrated that high-dose EPA (icosapent ethyl, 4g/day) reduced cardiovascular events by 25% in patients with elevated triglycerides. Omega-3s lower triglycerides, reduce platelet aggregation, improve endothelial function, and stabilize atherosclerotic plaque.
Cardiovascular
Lowers triglycerides 15-30%. Reduces resting heart rate. Improves arterial elasticity. Reduces risk of arrhythmia and sudden cardiac death.
Neurological
DHA supports synaptic function and myelination. Associated with reduced risk of depression, cognitive decline, and Alzheimer's disease. Critical during pregnancy for fetal brain development.
Anti-inflammatory
EPA and DHA are precursors to specialized pro-resolving mediators (SPMs) that actively resolve inflammation. Reduces CRP, IL-6, and other inflammatory markers implicated in chronic disease.
How to test and dose: The Omega-3 Index measures EPA + DHA as a percentage of total red blood cell fatty acids. Target: 8-12% (the range associated with the lowest cardiovascular risk). Most Americans are in the 4-5% range. To reach optimal levels, most adults need 2-4 grams of combined EPA + DHA per day from high-quality fish oil or algal oil. Quality matters — look for third-party tested products (IFOS certification) to verify purity and potency.
HOW MOONSHOT TESTS AND CORRECTS MICRONUTRIENT DEFICIENCIES
Guessing at supplements is expensive and ineffective. The supplement industry is built on guessing. Buy this multivitamin. Take this stack. Hope it works. That approach ignores the fundamental question: what are you actually deficient in, and how much do you need to reach optimal levels? At Moonshot, we test first, dose based on data, and verify with follow-up labs.
1. Comprehensive Panel
Our blood work covers the micronutrients that matter most: 25-OH vitamin D, RBC magnesium, ferritin, serum iron, TIBC, transferrin saturation, vitamin B12, serum zinc, and inflammatory markers (hs-CRP, homocysteine) that indicate micronutrient-related dysfunction. We also assess thyroid markers (TSH, Free T3, Free T4, Reverse T3) alongside micronutrients because the two are inseparable — you cannot optimize thyroid function without adequate selenium, iron, zinc, and vitamin D. The Omega-3 Index is available for patients focused on cardiovascular and neurological optimization.
2. Clinical Interpretation, Not Just Reference Ranges
A vitamin D of 32 ng/mL is "normal." A ferritin of 15 ng/mL is "normal." A B12 of 220 pg/mL is "normal." And a patient with all three of those values will feel terrible — tired, foggy, cold, losing hair, sleeping poorly, and struggling in the gym. We interpret results in the context of optimal ranges, your symptoms, your goals, and the interactions between markers. A low ferritin in the context of a suboptimal Free T3 tells a different clinical story than low ferritin alone.
3. Targeted Supplementation Protocols
Based on your results, we build a specific protocol — the right nutrients, the right forms, the right doses. Not a generic multivitamin. We specify the form of magnesium based on your primary concern, select the right iron formulation based on your tolerance and absorption capacity, and dose vitamin D based on your starting level and body composition. We also account for cofactor dependencies: vitamin D with K2 and magnesium, zinc balanced with copper, iron separated from calcium and thyroid medication.
4. Injectable Options for Severe Deficiency
For patients with severe deficiencies that aren't responding to oral supplementation — or who have absorption issues (gut inflammation, celiac disease, gastric bypass) — we offer injectable options. B12 injections (hydroxocobalamin or methylcobalamin) bypass the GI tract entirely, delivering 100% bioavailability. This is especially important for patients on metformin, those with pernicious anemia or intrinsic factor deficiency, and vegans with long-standing B12 depletion. We also offer NAD+ infusions for cellular energy optimization and DNA repair support.
5. Follow-Up Testing
Supplementation without follow-up is guessing with extra steps. We recheck levels 8-12 weeks after initiating protocols to verify you've reached optimal levels, adjust doses as needed, and ensure there are no issues with over-repletion (especially iron, where excess carries its own risks). The goal is to move from deficient or suboptimal to the optimal range — and keep you there.
COMMON QUESTIONS
Why are micronutrient deficiencies so common if I eat a healthy diet?
Modern food production has fundamentally changed what's in your food. Industrial farming has depleted soil mineral content by 20-40% over the past 50 years. Crops are bred for yield and appearance, not nutrient density. Processing strips vitamins and minerals further. On top of that, chronic stress, medications (PPIs, metformin, oral contraceptives), gut dysfunction, and higher metabolic demands from exercise all increase your requirements beyond what even a clean diet typically provides. A 2020 analysis in the journal Nutrients found that over 90% of Americans fail to meet the estimated average requirement for vitamin D, and over 50% fall short on magnesium. Eating well is necessary but often not sufficient — which is why testing, not guessing, is the only way to know where you actually stand.
How much vitamin D should I take daily?
The RDA of 600-800 IU per day is based on bone health and is far too low to reach optimal serum levels for most adults. Research from the Endocrine Society suggests that most adults need 4,000-5,000 IU per day to reach and maintain a 25-OH vitamin D level of 50-80 ng/mL — the range associated with the best outcomes for immune function, hormone production, mood, and cancer risk reduction. However, the right dose depends on your starting level, body composition (vitamin D is fat-soluble and sequestered in adipose tissue — heavier individuals need more), skin pigmentation, and sun exposure. This is why we test first and dose accordingly, rather than using a one-size-fits-all number. Vitamin D should always be taken with K2 and magnesium as cofactors.
What's the best form of magnesium to take?
It depends on what you're trying to address. Magnesium glycinate is the best general-purpose form — well-absorbed, gentle on the gut, and particularly effective for sleep quality and anxiety reduction due to glycine's calming effect. Magnesium threonate (Magtein) is the only form shown to cross the blood-brain barrier effectively, making it the best choice for cognitive function, memory, and neuroprotection. Magnesium taurate is preferred for cardiovascular support — taurine has independent benefits for blood pressure and heart rhythm. Avoid magnesium oxide — it has the highest elemental magnesium content but the worst absorption (around 4%), so most of it passes through you as a laxative. Many people benefit from stacking two forms — for example, glycinate at night for sleep and threonate in the morning for cognition.
My doctor says my iron is normal. Could I still be deficient?
Yes — this is one of the most common missed diagnoses in medicine. Most doctors check hemoglobin and hematocrit as part of a CBC. If those are in range, they tell you your iron is fine. But hemoglobin is the last thing to drop in iron deficiency — it only falls after your iron stores are completely depleted. Ferritin is the storage form of iron and drops long before hemoglobin does. A ferritin of 15 ng/mL is technically "in range" at most labs (reference range starts at 10-12), but it's functionally depleted. Patients with ferritin below 50 commonly experience fatigue, hair loss, brain fog, exercise intolerance, cold intolerance, and impaired thyroid conversion. Optimal ferritin is 50-150 ng/mL for women and 75-150 ng/mL for men. At Moonshot, we always test ferritin alongside a full iron panel — serum iron, TIBC, and transferrin saturation — because the complete picture matters.
Does Moonshot test for all of these micronutrients?
Yes. Our comprehensive blood panel includes 25-OH vitamin D, ferritin, serum iron, TIBC, transferrin saturation, vitamin B12, RBC magnesium, zinc, and inflammatory markers that indicate micronutrient-related dysfunction. We also offer the Omega-3 Index test for patients optimizing cardiovascular and neurological health. For patients with identified deficiencies that aren't responding adequately to oral supplementation — or for those who need faster repletion — we offer injectable options including B12 injections and NAD+ infusions. The goal is always to identify the specific bottleneck, correct it with the right form and dose, and verify with follow-up testing that you've actually reached optimal levels. Guessing at supplements without testing is expensive and ineffective.
References
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STOP GUESSING. START TESTING.
A comprehensive micronutrient panel identifies the specific bottlenecks holding back your energy, hormones, immune function, and performance. Targeted correction based on data, not marketing claims.
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