💡 What You Need to Know Right Away
A vitamin E blood test is a blood test that measures the amount of vitamin E (tocopherol) in your blood to check for deficiency or excess levels that could indicate malabsorption disorders or supplement toxicity.
Also known as: Serum Vitamin E, Tocopherol Test, Alpha-Tocopherol Test, Vitamin E Level, Plasma Vitamin E
- Research shows this test measures alpha-tocopherol, the most biologically active form of vitamin E in your blood[Evidence: C][6]
- In people with cystic fibrosis, research shows water-soluble vitamin E formulations helped increase vitamin E levels by about 30% after 6 months[Evidence: A][1]
- Research shows this test helps doctors understand the relationship between vitamin E intake and actual vitamin E levels in the blood[Evidence: A][2]
- In premature infants, studies suggest vitamin E supplementation reduced eye problems (retinopathy of prematurity) in about 6 out of 10 cases compared to those without supplementation[Evidence: B][3]
If your doctor has ordered a vitamin E blood test, you might be wondering what it measures and why it matters. It's common to feel uncertain about unfamiliar blood tests, especially when you're not sure what the results could mean for your health.
A vitamin E blood test helps your doctor check whether you have too little or too much vitamin E in your body. This fat-soluble vitamin plays a critical role as an antioxidant, protecting your cells from damage. Testing is particularly important for people with conditions that affect fat absorption, premature infants, and those taking high-dose vitamin E supplements.
In this guide, you'll learn what the test measures, how to prepare, what normal ranges look like, and what your results might mean. Whether you're a parent preparing your child for testing or an adult trying to understand your own results, this information will help you feel more confident about the process.
❓ Quick Answers
Is a vitamin E blood test painful?
A vitamin E blood test involves a standard blood draw, which causes a brief needle prick lasting 1-2 seconds. Most people describe it as a quick pinch similar to a bee sting. The entire blood collection takes less than 60 seconds, and tenderness at the puncture site typically resolves within 1-2 hours.
How long does a vitamin E blood test take?
The blood draw itself takes less than 5 minutes from start to finish. This includes tourniquet application (30 seconds), vein location (15-30 seconds), needle insertion and blood collection (30-60 seconds), and bandaging (30 seconds). Results typically take 2-5 business days to process at the laboratory.
Do I need to fast for a vitamin E test?
Most laboratories recommend fasting for 12-14 hours before your vitamin E blood test. Water is allowed during the fasting period. Fasting ensures accurate results because the clinical reference ranges were established using fasting blood samples. Check with your specific laboratory for their requirements.
What does low vitamin E mean?
Low vitamin E levels (below 4 mg/L or 12 µmol/L in adults) may indicate fat malabsorption disorders, which can lead to nerve problems and increased breakdown of red blood cells[Evidence: C][7]. Conditions like cystic fibrosis, Crohn's disease, celiac disease, and chronic liver disease can cause vitamin E deficiency.
What is a normal vitamin E level?
For adults, normal vitamin E (alpha-tocopherol) levels range from 5.5-17 mg/L (or 12.8-39.4 µmol/L). Early research suggests normal levels vary by age, gender, and season, so doctors compare your results to reference ranges specific to your characteristics[Evidence: C][10].
Who needs a vitamin E blood test?
Doctors typically order this test for people with fat malabsorption disorders (cystic fibrosis, Crohn's, celiac disease), premature infants at risk for deficiency, people receiving long-term parenteral (IV) nutrition, those with chronic liver or gallbladder disease, and individuals taking high-dose vitamin E supplements who need monitoring for toxicity.
Vitamin E Blood Test
Understanding your Alpha-Tocopherol levels is crucial for neurological health and immune function. Explore our guide to the Vitamin E (Alpha-Tocopherol) serum test.
🔬 How Does a Vitamin E Blood Test Work?
A vitamin E blood test measures the concentration of alpha-tocopherol in your serum or plasma. Alpha-tocopherol is the primary form of vitamin E that your body uses and stores. Early research suggests this is the most biologically active form and the most commonly tested biochemical indicator of vitamin E status[Evidence: C][6].
Think of vitamin E as your body's cellular security guard. It patrols cell membranes, protecting them from damage caused by harmful molecules called free radicals. When vitamin E levels are too low, these free radicals can damage your nerves, muscles, and eyes. When levels are too high from excessive supplementation, vitamin E can interfere with blood clotting and other protective systems.
The laboratory uses High-Performance Liquid Chromatography (HPLC) to measure vitamin E in your blood sample. Imagine HPLC as a highly sophisticated sorting machine. Your blood sample passes through a specialized column that separates vitamin E from all the other compounds in your blood, allowing precise measurement of the exact amount present.
Research shows this test helps doctors understand the relationship between vitamin E intake and actual circulating levels[Evidence: A][2]. Studies suggest people respond differently to vitamin E supplementation, with some showing much larger increases in blood levels than others[Evidence: B][4]. This individual variability is why testing matters. Your baseline vitamin E level can help predict how well you'll respond to supplementation if treatment is needed[Evidence: B][4].
Some laboratories also measure gamma-tocopherol, a secondary form of vitamin E found in foods like nuts and vegetable oils. However, alpha-tocopherol remains the primary clinical marker because it represents your body's active vitamin E stores.
🧪 What to Expect: The Real User Experience
During the Blood Draw
You'll sit in a phlebotomy chair or on an exam table with your arm extended. The phlebotomist wraps a tourniquet around your upper arm, creating firm pressure similar to a blood pressure cuff. This tightness lasts 2-3 minutes and makes your veins more visible. You may be asked to make a fist to help engorge the veins.
The alcohol swab feels cool on your skin but evaporates quickly within 5-10 seconds. The room is typically kept at 68-72°F, which some people find slightly cool in a hospital gown. The needle prick itself lasts only 1-2 seconds. Most people describe it as a quick pinch. You'll feel minimal sensation during the actual blood collection, which takes 30-60 seconds.
What You'll Feel After
Immediately after the draw, you may notice mild soreness at the puncture site. About 15-20% of patients develop a small bruise (purple or blue, about the size of a quarter) that resolves within 2-5 days. If you fasted for 12-14 hours, you might feel mild hunger or, if you're caffeine-dependent, a slight headache from skipping your morning coffee. These effects resolve quickly once you eat.
Rare complications (occurring in less than 1% of patients) include excessive bruising, prolonged bleeding (more common in people taking blood thinners), or very rarely, infection at the puncture site with sterile technique.
How to Make It Easier
- For the fasting period: Drink plenty of water (16-20 oz about 2 hours before the test). This reduces lightheadedness and makes your veins easier to find.
- If you're nervous about needles: Look away during insertion, practice deep breathing (inhale for 4 counts, exhale for 4 counts), and tell the phlebotomist you're anxious. They can use a smaller needle or numbing spray.
- To prevent bruising: Apply firm pressure to the puncture site for 2-3 full minutes after the needle is removed. Keep the bandage on for 1-2 hours and avoid heavy lifting with that arm for 2-3 hours.
- Schedule strategically: Book an early morning appointment to minimize fasting discomfort, and bring a snack to eat immediately after.
- For difficult veins: Stay well-hydrated, wear short sleeves or loose clothing, and ask for a warm compress on your arm if veins are hard to locate.
📊 Preparation & Reference Ranges
How to Prepare
- Fasting: Fast for 12-14 hours before your test. Water is allowed and encouraged.
- Supplements: Avoid vitamin E supplements for 24 hours before the blood draw unless your doctor specifically wants to measure your supplemented levels.
- Alcohol: Avoid alcohol for 24 hours before the test.
- What to bring: Insurance card, photo ID, and a list of all medications and supplements you take.
Normal Reference Ranges
Early research suggests serum alpha-tocopherol testing is the most commonly used method to check vitamin E levels[Evidence: C][7]. Reference ranges vary by age, and clinical guidelines recommend that results may differ between laboratories[Evidence: D][9].
| Age Group | Normal Range | Deficiency Threshold | Notes |
|---|---|---|---|
| Adults | 5.5-17 mg/L (12.8-39.4 µmol/L) | Below 4 mg/L (12 µmol/L) | Most common reference range |
| Children 0-6 months | 2.5-3.5 mg/L | Lower threshold | Age-adjusted values |
| Children 6 months-12 years | 3-9 mg/L | Age-dependent | Gradually increases with age |
| Adolescents 12-18 years | 6-14 mg/L | Approaching adult threshold | Near-adult ranges |
| Premature Infants | Lower than term infants | Requires close monitoring | Higher deficiency risk[3] |
Special Populations
In people with cystic fibrosis, research shows water-soluble vitamin E formulations helped increase vitamin E levels by about 30% after 6 months, while fat-soluble formulations did not maintain higher levels beyond 1 month[Evidence: A][1]. This finding is important for patients and doctors choosing between different supplement formulations.
In people with rare fat absorption disorders like abetalipoproteinemia or chylomicron retention disease, studies suggest water-soluble vitamin E (tocofersolan) is absorbed much better than standard vitamin E formulations[Evidence: B][5].
Lipid Standardization
If your blood lipid levels are unusually high or low, your doctor may calculate a lipid-standardized vitamin E ratio. This adjusts your vitamin E level based on your total cholesterol and triglycerides, providing a more accurate assessment of your true vitamin E status.
⚠️ Risks, Side Effects, and Warnings
The vitamin E blood test itself is a standard blood draw with minimal risks. It's normal to feel anxious about medical tests, but most people tolerate blood draws well.
Blood Draw Complications
- Bruising at puncture site: Occurs in 10-20% of patients. Resolves within 2-5 days.
- Lightheadedness: Occurs in 1-5% of patients, often related to fasting or anxiety. Usually resolves within minutes.
- Vasovagal syncope (fainting): Occurs in less than 1% of patients. More common in those with needle phobia.
- Prolonged bleeding: More common in people taking blood thinners. Apply pressure for longer if needed.
⚠️ Important Safety Information
- Tell your phlebotomist if you take blood thinners (warfarin, aspirin, clopidogrel) as you may need longer compression time.
- Avoid blood draw from arms with active cellulitis (skin infection). Use an alternative site.
- If you have severe bleeding disorders, alert the staff. The test is not contraindicated but requires prolonged compression.
- Seek medical attention if you experience excessive bleeding, signs of infection (increasing redness, warmth, pus), or severe bruising at the puncture site.
Understanding Your Results
In people with fat malabsorption disorders, early research suggests vitamin E deficiency may lead to nerve problems (peripheral neuropathy) and increased breakdown of red blood cells[Evidence: C][7].
Early research suggests taking high doses of vitamin E supplements (above 400 IU daily) may increase the risk of death and bleeding problems[Evidence: C][8]. Additionally, early research suggests very high vitamin E levels may interfere with normal immune function and the body's natural antioxidant systems[Evidence: C][8]. This is why monitoring is important for people taking supplements.
🥗 Practical Preparation Tips
Before Your Test
- Schedule for early morning: This minimizes the time you spend fasting and allows you to eat breakfast shortly after.
- Hydrate well: Drink 16-20 oz of water 2 hours before your appointment. Dehydration makes veins harder to find.
- Wear appropriate clothing: Short sleeves or loose-fitting tops allow easy access to your arm.
- Bring a snack: Pack something to eat immediately after your blood draw to stabilize blood sugar.
- List your medications: Include all prescription drugs, over-the-counter medications, and supplements, especially vitamin E products.
After Your Test
- Eat a protein-rich meal: This helps stabilize blood sugar after fasting.
- Avoid alcohol: Skip alcoholic beverages for the remainder of the day to support normal clotting.
- Rest the arm: Avoid heavy lifting with your blood draw arm for 2-3 hours.
- Keep the bandage: Leave it on for 1-2 hours to protect the puncture site.
Following Up on Results
Clinical guidelines recommend following up at the same laboratory for subsequent tests, as vitamin E measurements may vary between different labs[Evidence: D][9]. This ensures your results can be accurately compared over time.
What to Look for When Choosing a Lab
The quality of your vitamin E test results depends on the laboratory performing the analysis. Here's what to consider:
Lab Quality Markers
- CLIA certification: Clinical Laboratory Improvement Amendments (CLIA) accreditation is federally required. Why it matters: Ensures the lab meets basic quality standards for accurate results.
- CAP accreditation: College of American Pathologists certification represents a higher standard than CLIA alone. Why it matters: CAP-accredited labs undergo rigorous proficiency testing and inspections.
- Analytical methodology: HPLC (High-Performance Liquid Chromatography) with UV/fluorescence detection is the gold standard method. Why it matters: More advanced methods like LC-MS/MS provide even greater accuracy.
- Turnaround time: Most labs provide results within 2-5 business days. Why it matters: Faster results enable quicker treatment decisions if deficiency is found.
- Insurance acceptance: Verify in-network status before testing. Why it matters: Out-of-network labs can cost significantly more.
Questions to Ask Your Provider
- Which laboratory will process my sample?
- Is the lab CLIA-certified and CAP-accredited?
- Do I need to fast, and for how long?
- When will results be available?
- Who will explain my results to me?
- What is the cost if my insurance doesn't cover it?
Red Flags to Avoid
- No CLIA certification: Unlicensed labs lack quality oversight and may produce unreliable results.
- Unusually cheap pricing: May indicate an unaccredited lab or limited quality controls.
- No clear chain of custody: Your sample should be handled by trained personnel at every step.
- Pressure to add unnecessary tests: A vitamin E test can be ordered alone. You don't need a comprehensive panel unless clinically indicated.
Clinical guidelines highlight challenges in laboratory performance for vitamin E testing and recommend following up at the same laboratory for consistent results[Evidence: D][9].
How Vitamin E Test Compares to Vitamin D Test: What to Know
Both vitamin E and vitamin D are fat-soluble vitamins measured through blood tests, but they serve different purposes and have distinct clinical indications. Understanding the differences helps you know which test you might need.
| Feature | Vitamin E Blood Test | Vitamin D Blood Test |
|---|---|---|
| What It Measures | Alpha-tocopherol (primary active form) | 25-hydroxyvitamin D (storage form) |
| Primary Function | Antioxidant protection of cell membranes | Calcium absorption and bone health |
| Common Indications | Malabsorption disorders, premature infants, supplement monitoring | Bone disorders, fatigue, suspected deficiency, routine screening |
| Fasting Required | Yes (12-14 hours recommended) | No (usually not required) |
| Deficiency Prevalence | Rare in healthy populations[Evidence: C][7] | Common (estimated 40% of adults) |
| Results Turnaround | 2-5 business days | 1-3 business days |
| How Often Ordered | Less common (specific clinical indications) | Very common (routine health screening) |
Key Differences
Vitamin E deficiency is relatively rare in healthy people with normal diets, while vitamin D deficiency is widespread. Vitamin E testing is typically reserved for people with specific conditions affecting fat absorption, while vitamin D testing is often part of routine health screenings.
Early research suggests vitamin E deficiency is less common in Asia and more common in North America and Brazil among children[Evidence: C][7]. Geographic and dietary patterns influence the likelihood of deficiency for both vitamins.
Note: Your doctor will determine which test is appropriate based on your symptoms, medical history, and risk factors. These tests measure different vitamins with different clinical purposes.
What The Evidence Shows (And Doesn't Show)
What Research Suggests
- In people with cystic fibrosis, research shows water-soluble vitamin E formulations helped increase vitamin E levels by about 30% (mean difference 19.74 µmol/L) after 6 months[Evidence: A][1]
- In premature infants at risk for eye problems, studies suggest vitamin E supplementation reduced retinopathy of prematurity in about 6 out of 10 cases (12.5% vs 31% incidence)[Evidence: B][3]
- Research shows serum alpha-tocopherol testing is the most widely used biochemical indicator for vitamin E status[Evidence: C][7]
- Studies suggest people respond differently to vitamin E supplementation, with marked individual variability in blood level responses[Evidence: B][4]
- Research shows this test helps doctors understand the relationship between dietary vitamin E intake and actual circulating levels[Evidence: A][2]
What's NOT Yet Proven
- Optimal vitamin E supplementation dosages for different populations remain unclear. Studies used varying amounts with different results.
- Long-term neurological outcomes from early vitamin E deficiency treatment require additional longitudinal research beyond current study durations.
- Population-specific reference ranges continue to be established. Current ranges may not account for all ethnic, dietary, and geographic variations[Evidence: C][10].
- The clinical significance of gamma-tocopherol levels (vs alpha-tocopherol alone) is not fully established in routine practice.
Where Caution Is Needed
- High-dose vitamin E supplementation (above 400 IU daily) may increase mortality risk and bleeding complications[Evidence: C][8]
- Laboratory measurements may vary between different testing facilities, making serial monitoring at the same lab important[Evidence: D][9]
- Fat-soluble vitamin E formulations may not provide sustained improvement in people with malabsorption disorders. Water-soluble formulations are preferred for these patients[Evidence: A][1]
- Interpreting results requires considering individual factors including age, lipid levels, and underlying medical conditions
Should YOU Get This Test?
Best suited for: People with fat malabsorption disorders (cystic fibrosis, Crohn's disease, celiac disease, chronic liver disease), premature infants, individuals receiving parenteral nutrition, and those taking high-dose vitamin E supplements who need monitoring.
Not recommended for: Routine screening in healthy adults without risk factors. Vitamin E deficiency is rare in people with normal diets and no malabsorption conditions.
Realistic timeline: Blood draw takes less than 5 minutes. Results typically available within 2-5 business days. Follow-up testing intervals depend on your specific condition and treatment plan.
When to consult a professional: If you have symptoms of vitamin E deficiency (muscle weakness, vision problems, coordination difficulties, numbness), conditions affecting fat absorption, or if you're taking high-dose vitamin E supplements and want to monitor for toxicity.
Frequently Asked Questions
What does high vitamin E mean?
High vitamin E levels typically result from excessive supplementation rather than diet. Early research suggests taking high doses of vitamin E supplements (above 400 IU daily) may increase the risk of death and bleeding problems . High vitamin E can interfere with normal blood clotting and may interact with blood-thinning medications. If your levels are elevated, your doctor will likely recommend reducing or stopping supplements. Vitamin E toxicity from food alone is extremely rare because vitamin E from dietary sources is well-regulated by your body.
What is alpha-tocopherol vs gamma-tocopherol?
Alpha-tocopherol is the primary form of vitamin E that your body preferentially uses and stores. It's the form measured in standard vitamin E blood tests. Gamma-tocopherol is found in foods like nuts, seeds, and vegetable oils but is present at lower concentrations in blood. Studies suggest baseline vitamin E (alpha-tocopherol) levels help predict how well someone will respond to supplementation . Some specialized labs measure both forms, but alpha-tocopherol remains the primary clinical marker for assessing vitamin E status.
Can I take vitamin E supplements before the test?
Generally, you should avoid vitamin E supplements for 24 hours before your blood test to get an accurate baseline measurement. However, if your doctor specifically wants to monitor your supplemented levels (such as checking for toxicity or confirming adequate absorption), they may ask you to continue your normal supplement routine. Always follow your doctor's specific instructions. Taking supplements right before the test can artificially elevate results and may not reflect your true vitamin E status.
What conditions cause vitamin E deficiency?
Vitamin E deficiency is most commonly caused by conditions that impair fat absorption, since vitamin E is a fat-soluble vitamin. These include cystic fibrosis, Crohn's disease, celiac disease, chronic pancreatitis, short bowel syndrome, and chronic liver diseases with cholestasis. Rare genetic disorders like abetalipoproteinemia and ataxia with vitamin E deficiency (AVED) also cause deficiency. In people with fat malabsorption disorders, early research suggests deficiency may lead to nerve problems and increased breakdown of red blood cells .
Is the vitamin E test covered by insurance?
Coverage varies by insurance plan and medical necessity. Most insurance plans cover the vitamin E blood test when ordered for specific clinical indications such as malabsorption disorders, neurological symptoms of unknown cause, or monitoring in high-risk populations like premature infants. Elective testing without documented medical necessity may not be covered. Contact your insurance provider to verify coverage before your test. Out-of-pocket costs typically range from $48 to $307 depending on the laboratory and location.
How accurate is the vitamin E blood test?
The vitamin E blood test is highly accurate when performed by accredited laboratories using validated methods like HPLC. However, clinical guidelines recommend following up at the same laboratory for subsequent tests because measurements may vary between different labs . Factors that can affect accuracy include improper fasting, recent high-dose supplementation, and abnormal blood lipid levels (which may require lipid-standardized calculations). Consistent sample handling and quality-controlled laboratory processes ensure reliable results.
What happens if vitamin E is too high?
Very high vitamin E levels, typically from excessive supplementation, can cause several problems. Early research suggests this may interfere with normal immune function and the body's natural antioxidant systems . High vitamin E can also potentiate the effects of blood-thinning medications, increasing bleeding risk. Symptoms of vitamin E excess may include nausea, diarrhea, fatigue, and increased bruising. Treatment involves stopping or reducing vitamin E supplements. Your doctor will monitor levels until they return to normal.
How much does a vitamin E blood test cost?
The cost of a vitamin E blood test varies significantly depending on the laboratory, location, and insurance coverage. Direct-to-consumer labs typically charge between $48 and $150 for standalone testing. Hospital laboratories may charge $150 to $307 or more before insurance adjustments. With insurance coverage for medically necessary testing, your out-of-pocket cost may be limited to your copay or coinsurance. Check with your specific laboratory and insurance provider for accurate pricing before scheduling your test.
Our Accuracy Commitment and Editorial Principles
At Biochron, we take health information seriously. Every claim in this article is supported by peer-reviewed scientific evidence from reputable sources published in 2015 or later. We use a rigorous evidence-grading system to help you understand the strength of research behind each statement:
- [Evidence: A] = Systematic review or meta-analysis (strongest evidence)
- [Evidence: B] = Randomized controlled trial (RCT)
- [Evidence: C] = Cohort or case-control study
- [Evidence: D] = Expert opinion or clinical guideline
Our editorial team follows strict guidelines: we never exaggerate health claims, we clearly distinguish between correlation and causation, we update content regularly as new research emerges, and we transparently note when evidence is limited or conflicting. For our complete editorial standards, visit our Editorial Principles page.
This article is for informational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals before making changes to your health regimen, especially if you have medical conditions or take medications.
References
- 1 . Vitamin E supplementation in people with cystic fibrosis, The Cochrane database of systematic reviews, 2020, Okebukola PO, Kansra S, Barrett J. PubMed | DOI [Evidence: A]
- 2 . Vitamin E and Multiple Health Outcomes: An Umbrella Review of Meta-Analyses, Nutrients, 2023, Xiong Z, Liu L, Jian Z, et al. PubMed | DOI [Evidence: A]
- 3 . Efficacy of water-based vitamin E solution versus placebo in the prevention of retinopathy of prematurity in very low birth weight infants, Medicine, 2021, Romero-Maldonado S, Montoya-Estrada A, Reyes-Muñoz E, et al. PubMed | DOI [Evidence: B]
- 4 . Alpha-Tocopherol Metabolites (the Vitamin E Metabolome) and Their Interindividual Variability during Supplementation, Antioxidants (Basel, Switzerland), 2021, Bartolini D, Marinelli R, Giusepponi D, et al. PubMed | DOI [Evidence: B]
- 5 . Efficacy of two vitamin E formulations in patients with abetalipoproteinemia and chylomicron retention disease, Journal of lipid research, 2018, Cuerq C, Henin E, Restier L, et al. PubMed | DOI [Evidence: B]
- 6 . Human Vitamin E deficiency, and what is and is not Vitamin E?, Free radical biology & medicine, 2024, Traber MG. PubMed | DOI [Evidence: C]
- 7 . Vitamin E deficiency in childhood: a narrative review, Nutrition research reviews, 2023, Lobo LMC, Hadler MCCM. PubMed | DOI [Evidence: C]
- 8 . Vitamin E (α-Tocopherol): Emerging Clinical Role and Adverse Risks of Supplementation in Adults, Cureus, 2025, Kaye AD, Thomassen AS, Mashaw SA, et al. PubMed | DOI [Evidence: C]
- 9 . Quality assurance programs for vitamin A and E in serum: are we doing enough to assess laboratory performance?, Clinical chemistry and laboratory medicine, 2024, Fitzpatrick M, Andersen T, Bush J, et al. PubMed | DOI [Evidence: D]
- 10 . Establishment of Reference Range for Serum Concentration of Vitamin A and Vitamin E in Southern Sichuan Area of China, Journal of clinical laboratory analysis, 2024, Ye Q, Zhong Q, Huang G, Zhang W. PubMed | DOI [Evidence: C]
Medical Disclaimer
This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers are advised to consult their doctors or qualified health professionals regarding specific health questions and before making any changes to their health routine, including starting new supplements.
Neither Biochron nor the author takes responsibility for possible health consequences of any person reading or following the information in this educational content. All readers, especially those taking prescription medications, should consult their physicians before beginning any nutrition, supplement, or lifestyle program.
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