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Blood Tests for Vegan Adults and Children: How Often and Which Ones to Get?

Alina Petre, MSc. RD.

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Which are the best blood tests for vegan families to request? How often and at which frequency should they be requested? These are the topics of today’s article.

Periodic bloodwork is a great way to track your health on a vegan diet. This month, my family and I are planning to get ours.

This made me contemplate the fact that, before stepping foot into my office, few of my nutrient clients ever got a blood pannel done before.

As a vegan registered dietitian, I often get asked whether bloodtests are a good idea. And if so, which ones to get. Parents also often wonder whether vegan children should also get regular blood tests.

So I thought I’d answer these questions (and more) in this article, and add it to the Q&A with a dietitian series.

As always, if you prefer to watch (or listen) to my views on this topic, simply click on the video below. Otherwise, feel free to carry-on reading!

Why consider getting blood tests for vegan adults or children?

Before we get into the topic of this week’s video, I think it’s important to mention that a well-planned vegan diet can be suitable for all stages of life. 

This isn’t just my personal opinion, but also that of various nutrition organizations around the world, including the American dietetics association and the British dietetics association (1, 2).

But despite having the best of intentions, very few people consistently make ideal diet choices day in and day out. This is why I believe that periodic checks are worth doing. These will allow you to make sure that your diet is truly meeting your nutrition needs.

There are many ways to check whether your diet provides you with all the nutrients you need, and blood tests are just one of your options.

They are by no means perfect, because, so far, it’s impossible to check your nutrition status through one simple blood test.

Nonetheless, bloodwork is definitely one useful tool to have in your toolbox. This is why I often encourage my vegan clients to get their blood values checked on a yearly basis.

As a side note, I also encourage my non-vegan clients to do the same! Eating animal products offers no guarantee that your diet will meet all of your nutrient needs. But that’s a topic for another article.

Which blood tests for vegans to request?

If you’re thinking about getting vegan bloodwork done, here are the main tests I would recommend you consider getting.

Depending on where you live, you’ll probably need to request them through your family doctor or pediatrician. That said, in some places, you may be able to request them directly from a private blood testing facility.

Vitamin B12

Vitamin B12 is only found in animal products or fortified foods. So vegans, especially those not supplementing or supplementing incorrectly, are at risk of getting too little of it.

This is why vitamin B12 typically tops my list of nutrients to check.

Vitamin B12 stores can take years to become depleted before outwardly signs of a deficiency begin to appear.

So if you’ve been eating a vegan diet for a while, but haven’t been taking any vitamin B12 supplements, it’s even more crucial for you to get your levels checked (3).

If you’ve been supplementing vitamin B12 regularly, in the right dosages, your vitamin B12 levels are likely to be fine.

That said, I recommend you still get them checked because knowing your blood levels will help you tailor your supplementation regimen accordingly.

Some people have difficulty absorbing vitamin B12. So getting your levels checked can also help confirm whether you’re actually absorbing your oral vitamin B12 supplements.

Which vitamin B12 blood tests to request

There are several ways to test vitamin B12 levels, with varying levels of accuracy and cost. The main ones are (4):

In terms of accuracy, MMA levels are commonly considered to be the most representative of your true B12 status.

Active vitamin B12 levels are a close second in terms of accuracy. That said, recent research suggests that in people over the age of 50, active B12 levels may as, if not more accurate than MMA levels.

For those paying out of pocket, it’s worth noting that an active vitamin B12 tends to be cheaper too.

Total B12 levels are the cheapest to test, but are usually considered less accurate than active B12 levels.

That said, new research suggests that in men and in women under 50 years old, total B12 levels are just as accurate at picking up on a vitamin B12 deficiency as an active B12 or MMA test (4).

So, depending on your budget, I suggest you request either a total or active vitamin B12 test.

If you have symptoms of a vitamin B12 deficiency, such as fatigue, swelling of the tongue, pale skin and tingling in the hands and feet, but your total or active B12 levels seem normal, I’d strongly suggest you also request a MMA test. 

IN SUM – A total or active vitamin B12 test will generally give a good representation of your vitamin B12 status. However, in some cases, an MMA test may also be worth doing.

Iron

A vegan diet can be very rich in iron. In fact, at times, a vegan diet is even richer in iron than one containing animal products.

The caveat is that the type of iron found in plant foods is less easily absorbed by our bodies than the iron found in animal foods. 

This is why vegans typically need to eat larger quantities of iron-rich foods than non-vegans (5). 

There are various ways you can help your body absorb more iron from plant foods. Soaking, sprouting, fermenting, are a few.

Combining plant-foods rich in iron with foods rich in vitamin C, and not having coffee, tea, or calcium-rich foods at the same time as iron-rich ones is also helpful.

Cooking with cast-iron pots and pans, or using a lucky iron fish are a few additional options.

I’ve written a comprehensive article about iron on a vegan diet, so feel free to check that out if you want to learn more about this topic.

If you have young children at home, you may also find this article about iron for vegetarian and vegan babies helpful.

Keep in mind that despite these methods to boost iron absorption from plants, many vegans have low iron levels. So getting yours checked on a yearly basis can help pick up on this before an iron depletion progresses to an iron deficiency (5).

Which iron blood tests to request

The two most popular ways to check your iron status are through your (6): 

I consider it important to test both, because you may have normal hemoglobin levels but low ferritin levels. This can be an early sign of iron depletion, which, if left untreated, can cause your hemoglobin levels to drop as well (6).

If treated right away, low iron levels will be much quicker and easier to restore back to a normal level. As a result, you’ll be much less likely to experience the unpleasant physical symptoms of an iron deficiency.

It’s especially important to request both tests during pregnancy. Depending on where you live, some practitionners still only check your hemoglobin levels, unless you specifically request for ferritin levels to be tested as well.

I’ve seen normal hemoglobin results coupled with low ferritin levels in several clients. I’ve also seen this iron depletion happen during both of my vegan pregnancies.

Pregnancy is a time during which iron requirements increase dramatically, and the parent’s iron status will directly influence their baby’s. So all the more reason to pick up and treat any form of iron deficiency quickly. 

IN SUM – Despite many plant foods being rich in iron, vegans tend to have lower blood iron levels than non-vegans. Vegans are also more likely to experience an iron deficiency. You can check your own iron status by getting your hemoglobin and ferritin levels tested.

Thyroid hormones

As a vegan, you may want to consider occasionally checking your thyroid function. You can do this by getting your thyroid hormone levels checked..

I especially recommend such testing if you’re currently pregnant, postpartum, or wishing to become pregnant. I also recommend you get your thyroid hormone levels checked if you don’t consistently get enough iodine from your diet (7).

Iodine’s impact on thyroid hormones

Iodine is a nutrient that directly affects the functioning of your thyroid gland, which controls your metabolism. Too little iodine can cause your thyroid to slow down. In turn, this can cause you to feel tired and depleted.

A slow thyroid may also result in memory loss, feelings of depression, unexplained weight gain and tingling in the hands and feet (8). 

Keep in mind that getting too much iodine isn’t good either. This can cause your thyroid to become overactive – a condition also known as hyperthyroidism.

Symptoms of hyperthyroidism include an irregular heartbeat, shaky hands and unexplained weight loss (7). 

Due to soil mineral depletion, you’re especially at risk of getting too little iodine on a vegan diet.

This is particularly the case if you don’t eat consume iodized salt, iodine-enriched foods, seaweed, or an iodine supplement regularly, or in large enough amounts (9, 10, 11).

I consider an iodine supplement the most reliable source of iodine in a vegan diet. So if you haven’t been taking one up to this point, you may want to consider getting your thyroid hormone levels checked.

Pregnancy’s impact on thyroid hormones

Iodine requirements increase during pregnancy. In addition, a small number of women can experience thyroid dysfunction during pregnancy or in the postpartum period (7).

So if you’re currently pregnant or have recently given birth, getting your thyroid hormones checked may also be a good idea.

Which thyroid function tests to request

You can check wether your thyroid gland is functioning optimally by getting your thyroid hormones – usually TSH, T4, and T3 levels – checked (12).

If you have a consistent and reliable source of iodine in your diet, aren’t pregnant or postpartum, and aren’t experiencing any symptoms of thyroid dysfunction, thyroid hormone testing is probably not useful for you.

IN SUM – Vegans who are pregnant, postpartum, planning to become pregnant, or not regularly taking an iodine supplement may benefit from getting their thyroid hormone levels checked.

Vitamin D

This is a blood test that I recommend to all of my clients, whether vegan or not.

Vitamin D can be made through sun exposure. However, your body’s ability to produce enough vitamin D from the sun depends on several factors. For instance, your age, where you live, the amount of body fat you have, and your skin tone (13).

If you’re above 50 years old, obese, or have a dark skin tone, you may be especially at risk of not producing enough vitamin D from sun exposure alone (14).

This is also true if you have limited access to the sun, either due to the location or climate you live in (14). 

Also, don’t forget that, in order to produce enough vitamin D, your skin should be free of sunscreen when exposed to the sun.

However, doing so may increase your risk of skin cancer, which is why most dermatologists don’t recommend regular unprotected sun exposure as a way to meet vitamin D needs (15).

For these reasons, a vitamin D test is likely worth doing once per year, especially if you don’t consistently take any vitamin D supplements.

To get the most out of your test, consider getting it done at the end of the winter. That’s when your vitamin D levels are likely to be at their lowest. So if you’re within the normal range then, you’re likely to remain so all year-round.

Which vitamin D test to request

The best way to measure your vitamin D status is to get your serum 25-hydroxyvitamin D [25(OH)D] levels checked.

Serum 25(OH)D levels are a good representation of the body’s total vitamin D stores, and the main indicator of your vitamin D status (13, 16).

IN SUM – Most people, vegan or not, would benefit from getting their vitamin D levels checked. The best way to do is this to measure serum 25(OH)D levels at the end of winter.

Blood sugar and cholesterol levels

Depending on your age, it may also be worth checking your blood sugar or cholesterol levels while you’re at it. 

A blood cholesterol panel is a good indicator of the health of your heart and circulatory system.

It’s a great way to establish your risk of heart disease and stroke, and, depending on where you live, a blood cholesterol pannel is recommended starting as early as 9-11 years old (17).

But in my opinion, most children eating a minimally processed vegan diet don’t actually need to get their blood cholesterol levels checked from such an early age.

Adults between 20-45 should consider getting a blood cholesterol pannel once every five years. In older adults, a repeat test is recommended every one to two years (17).

Getting your blood sugar levels tested can help screen for diabetes. Blood sugar screening is usually recommended starting around 40 years of age, and should ideally be repeated every 3 years (18).

However, screening for both cholesterol and blood sugar levels may be encouraged starting from a younger age or at a closer frequency if you have a family history of high cholesterol, heart attack, stroke, or diabetes, or other risk-factors for these diseases.

Which tests to request

A blood cholesterol pannel typically includes getting your total-, HDL-, and LDL-cholesterol as well as your triglyceride levels checked.

The most typical ways to test your blood sugar levels are through a fasting blood glucose or a glycated hemoglobin test – also known as a hemoglobin A1C measurement.

The first is probably the cheapest of the two, but the second tends to give you a better picture of your average blood sugar levels over the last 3 months or so. 

Another way to test blood sugar levels is through an oral glucose tolerance test. This one is most typically offered during pregnancy, or as a second testing method in people with high fasting blood sugar or hemoglobin A1C values. 

IN SUM – Blood sugar, cholesterol, and triglyceride levels may also be worth testing, especially in adults, and those with a family history of heart disease, stroke or diabetes.

Should vegan children get regular blood tests too?

Vegan children can benefit from getting regular blood tests too.

So far, I’ve gotten the family’s bloodwork done on a more-or-less yearly basis.

Children can be notorious picky eaters. So providing them with a balanced plant-based diet is no guarantee that they’re actually meeting their nutrient needs from it. So for me, blood tests are a good way to periodically check how we’re all doing.

I’m also not a fan of “just in case” supplementing, especially if I can avoid it. So keeping track of certain values helps me adjust my family’s supplementation regimen and to provide my children with only the supplements they currently need.

Which blood tests to request for vegan children?

The blood tests I typically request for my children are an active vitamin B12 test, a serum 25(OH)D, blood hemoglobin and ferritin. The last two are the ones I keep the closest eye on because iron is such an important nutrient for development.

Plus, many children – both vegan and not – fail to get enough iron from their diet, especially when they’re very little. And unlike vitamin B12 and vitamin D, iron is not a nutrient that I routinely supplement, unless it’s truly needed.

So far, iron supplementation hasn’t been necessary.

However, I continue to keep a close eye on my children’s hemoglobin and ferritin levels to see whether diet adjustments are in order, or whether supplements may be temporarily needed until they can fully meet their requirements from diet alone. 

Alternatives to getting a blood test for vegan children

Having said that, I realize that some parents may have limited access to blood testing.

Others may prefer providing their children with a low-dosage iron supplement as a preventative measure, rather than a corrective one. Especially if it means sparing their child an encounter with a sizeable needle.

If any of my children ever expresses a strong fear or resistance to getting their blood drawn for screening purposes, I reserve myself the right to switch over to this strategy as well!

If supplementing on a “just in case” basis is your preference, make sure you aren’t exceeding the daily recommendations for your child’s age group for each supplemented nutrient. 

Periodically entering a few days of what your child eats in an online food journal such as Cronomter is an alternative way to double-check whether their diet is currently meeting their nutrient needs.

IN SUM – Just like adults, vegan children can also benefit from regular bloodwork. However, parents may be understandably reticent and prefer using “just in case” supplementing until their children are older, or even adults themselves.

To sum it all up

Regular blood screening is generally a good idea for adults, whether vegan or not.

In addition to cholesterol, blood sugar, and vitamin D screening, vegans may also want to screen their vitamin B12 and iron status. In certain cases, a thyroid function screening may also be beneficial.

How often to get bloodwork done will depend on what you want tested. But generally, blood tests for vegans be done on a yearly basis.

Like adults, vegan children can also benefit from regular blood testing. However, parents may feel reticent to getting blood drawn from their children.

If this is the case for you, consider using alternative methods to check that your child’s diet meets their nutrient needs or making use of “just in case” appropriately.

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