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Comment by invalidname | Hacker News Reader

But wouldn't patients see deficiency in blood tests and get extra supplements for those two?

From the experience I have from doctors in Portugal, they will ignore that. My brother was not even warned by the doctor that he was pre-diabetic after checking his blood results.

You don't see tissue deficiencies in blood tests. You can have a local (e.g. brain) deficiency in the making for 30 years before it hits you and no blood test will show it as your body works hard on having perfect blood all the time.

IF they're tissue deficiencies. Many B vitamins get processed and flushed within hours with some get elevated blood levels for days.

B vitamin levels beyond B12 are rarely tested. You're unlikely to ever get it checked unless you experience specific neurological issues. Overtesting itself is dangerous, so... doctors don't have the incentive.

B12 can be tricky to pin down. It can be falsely elevated by vitamins.

You need cofactors, e.g. a B2 deficiency could falsely give the impression of repletion.

This is ON TOP of the really loose grounding of accepted ranges for various vitamins. Many of the levels are established on the basis of avoiding severe disease like vitamin D: "no rickets above this level" and B12: "no anemia above this level." Which is completely different than assessing optimal levels.

> This is ON TOP of the really loose grounding of accepted ranges for various vitamins. Many of the levels are established on the basis of avoiding severe disease like vitamin D: "no rickets above this level" and B12: "no anemia above this level." Which is completely different than assessing optimal levels.

This is concerning. Is there anyone keeping a database of optimal rather than minimal levels?

Dangerous in a sense: costs money right now, we would have to deal with it. My friend once said: “no one is healthy, your doctor just does not have the testing resolution to find the issues” and in 3 years you get parkinsons…

That's too cynical. In reality, you're going to die with a number of completely benign issues. The more issues you find and try to interfere, the more likely you are to have a negative impact. And that's before running into issues with testing failures from a large number of tests. We not only can't find all issues, we can find more other issues than are ever going to be an actual problem.

But it's not really a money issue (not in a lot of cases anyway) - where it leads to better outcomes, doctors do aim for overdiagnosing to a certain % to cover cases which would be otherwise missed.

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