Basic vitamin check – vitamin test: B12, folate, D, E & Q10 (blood)

Vitamin B12 (cobalamin) is needed for blood formation, the nerves and DNA synthesis. Deficiency results from too little intake from food, poor utilisation or impaired absorption in the gut, for example after stomach surgery or with bowel diseases (PubMed 28660890, PubMed 28189172). Older people and people who eat few or no animal foods are particularly affected (PubMed 28660890).

Important for interpretation: the test measures total B12 in the blood. There is no single "gold standard" test; cut-offs for deficiency are debated, and borderline values are clarified with further markers such as holotranscobalamin or methylmalonic acid (PubMed 24942828, PubMed 28660890).

A high B12 value often results from supplements, injections or fortified foods. Without such intake, an elevated value can also occur with certain liver and blood diseases; a review therefore considers medical assessment appropriate if an elevated value is not explained by intake (PubMed 14636871).

Folic acid (folate, vitamin B9) is needed for cell division and blood formation. Deficiency can lead to anaemia with enlarged red blood cells (megaloblastic anaemia); unlike B12 deficiency, it does not cause nerve damage (PubMed 28189172). Causes include a low-folate diet, impaired absorption in the gut and increased demand. Folate deficiency in early pregnancy is associated with a higher risk of neural tube defects in the child (PubMed 30228213).

The folate value in the blood is a snapshot; folate in red blood cells, by contrast, reflects roughly the last four months (PubMed 30228213). A high value usually results from supplements or fortified foods. Large amounts of folic acid can mask the anaemia of B12 deficiency; folic acid and B12 are therefore considered together (PubMed 38987872).

Vitamin E (alpha-tocopherol) is a fat-soluble vitamin that protects cell membranes against oxidation. Pronounced deficiency is rare and occurs mainly with impaired fat absorption or hereditary diseases. Very low levels have been associated with infections, anaemia and growth problems (PubMed 25469382).

The blood level depends strongly on blood lipids: people with higher blood lipid levels often have more vitamin E in the blood without more of it reaching the tissues. A low value is therefore more meaningful than a high one (PubMed 25469382). High values usually result from supplements.

Coenzyme Q10 (ubiquinone) is involved in energy production in the mitochondria and is produced by the body itself; food contributes only a little. Primary deficiency due to genetic changes is rare and well described. Secondary deficiency is discussed, among other things, in connection with cholesterol-lowering drugs of the statin group (PubMed 23452285).

Coenzyme Q10 is transported in the blood together with blood lipids. The report states the laboratory's reference range and an additional range given by the laboratory; what a value means for you belongs in the results consultation.

The test measures 25-OH vitamin D, the storage form of vitamin D in the blood (PubMed 29141976). In Germany, 61.6% of adults in the DEGS1 study had values below 50 nmol/l, considerably more in winter than in summer (PubMed 26162848). Long-lasting, pronounced deficiency can cause softening of the bones with bone pain and muscle weakness (PubMed 17634462). The value is explained in detail on the vitamin D test page.

Vitamin deficiency means that the body has less of a vitamin than it needs. Clear deficiency often shows typical consequences, such as anaemia with B12 or folate deficiency. More common is mild, "subclinical" deficiency: a lab value is low without complaints. For B12, depending on the definition, this affects 2.5 to 26% of the population; its significance is unclear (PubMed 28660890).

A blood test shows the concentration of a vitamin in the blood at the time of sampling. This is a snapshot: supplements, fortified foods and the season (for vitamin D) influence the value. Not every blood level reflects tissue supply – for vitamin E, for example, it depends on blood lipids, and for B12 the cut-offs are debated (PubMed 25469382, PubMed 24942828).

The report states the laboratory's reference range for each value and, for some values, additional ranges given by the laboratory. A value outside these ranges is an indication, not a diagnosis.

Described groups include: older people and people eating few or no animal foods for B12 (PubMed 28660890); people with impaired absorption in the gut or after gastrointestinal surgery for B12 and folic acid (PubMed 28189172); people with impaired fat absorption for vitamin E (PubMed 25469382); statin use for coenzyme Q10 (under discussion, PubMed 23452285); and for vitamin D little sun, higher body weight and the winter months (PubMed 26162848).

A risk does not mean that deficiency is present; it is a reason to discuss the question with a professional.

Research associates deficiency of the measured vitamins with the following complaints, with varying strength of evidence:

• Fatigue, pallor and reduced performance due to anaemia with B12 or folate deficiency: well documented (PubMed 28189172).
• Tingling, numbness, unsteady gait and problems with concentration and memory with B12 deficiency: well documented; nerve damage can be permanent without treatment (PubMed 28660890, PubMed 24942828).
• Bone pain and muscle weakness with pronounced vitamin D deficiency (osteomalacia): well documented (PubMed 17634462).
• Susceptibility to infection and anaemia with very low vitamin E, mostly only with impaired fat absorption: observed in studies (PubMed 25469382).
• Changes in skin, hair and nails: described for several micronutrient deficiencies, including B12 and vitamin E (PubMed 31144371).
• Muscle weakness and exercise intolerance with coenzyme Q10 deficiency: described in rare primary deficiency, under discussion for secondary deficiency (PubMed 23452285).

Many of these complaints are non-specific and often have other causes.

These are associations from studies and textbook knowledge, not causes in an individual person. A blood test cannot explain complaints and does not provide a diagnosis. Persistent complaints should first be assessed by a doctor.

With tingling or numbness in hands and feet, unsteady gait, severe fatigue with pallor, shortness of breath or palpitations, the first step is a doctor's practice, not a self-test. B12 deficiency with nerve symptoms should be treated promptly, because damage can otherwise remain.

When planning a pregnancy and during pregnancy, questions about folic acid and B12 belong with a gynaecologist. With chronic bowel diseases, after stomach or bowel surgery and with medication that can affect vitamin absorption, vitamin supply also belongs in medical care.

This page does not recommend supplements, diets or therapies. Whether a value means anything at all and which steps make sense depends on your overall situation: complaints, previous illnesses, medication and diet. Taking supplements without a basis is not harmless: too much vitamin D can be harmful (PubMed 30294301), and large amounts of folic acid can mask B12 deficiency (PubMed 38987872).

What makes sense for you belongs in a conversation with the ORY expert team or with your doctor or naturopath, for example from the ORY expert network. The results consultation is included in the price.

You do not need to fast. Drink enough water beforehand and warm your hands well. Clean your middle or ring finger with the alcohol swab and let the alcohol dry completely. Prick the side of the fingertip, wipe away the first drop and fill the CapiSave tube up to the 600 µl mark without squeezing; if one prick is not enough, use the second lancet on another finger.

State on the request form whether you take vitamin supplements, as they influence the values. Do not store the sample in heat or sunlight and send it on the day of sampling if possible, from Monday to Thursday.

Analysis usually takes 7–21 days from the arrival of the sample at the laboratory. As soon as your report is ready, we let you know. A results consultation with the ORY expert team is included in the price.

The basic vitamin check costs €98.50 including VAT, shipping, return postage and results consultation.

Statutory health insurance in Germany generally does not cover vitamin tests you order yourself. With private insurance, reimbursement may be possible; how it works is described under "Reimbursement by private insurance".

The basic vitamin check (€98.50) measures folic acid, vitamin B12, vitamin D, vitamin E and coenzyme Q10. The vitamin D test (€39.90) measures only vitamin D. The OM Vital blood test (€205) combines vitamins with blood lipids, liver and kidney values, hs-CRP and TSH. Minerals are measured by the whole blood mineral analysis (€75), fatty acids by the omega-3/6 test (€90). For children there is the vitamin check for children & adolescents (€106.50).

Which scope makes sense can be clarified in the free initial consultation.