Overcoming Nutritional
Deficiencies

Many people suffer from low-level shortages of critical nutrients and
don’t even know it. Are you one of them?

By Linda Melone

January 2010

Pellagra. Scurvy. The words seem almost quaint now, and many people wouldn’t recognize them. But pellagra was feared throughout areas of the southern US into the early 20th century, its sufferers marked by the “four Ds”: diarrhea, dermatitis, dementia and death. Go back another hundred years and sailors dreaded scurvy, a disease that caused teeth to fall out and open sores to appear before eventually killing its victims. In time, scientists would realize that both diseases were caused by deficiencies in key nutrients that would come to be known as vitamins: niacin (vitamin B3) in the case of pellagra, vitamin C in the case of scurvy.

Stark deficiencies such as pellagra and scurvy are rare in the modern developed world. But nutrient “insufficiencies” run rampant, fueled by a diet that favors convenience and speed over nutrition and quality. “People with nutrient insufficiencies or suboptimal levels of nutrients usually don’t even know it,” says Allan Magaziner, DO, author of Total Health Handbook: Your Complete Wellness Resource (Kensington) and medical director of the Magaziner Center for Wellness in Cherry Hill, New Jersey.


While their consequences may not be immediate, over time nutrient insufficiencies put you at a greater risk of infectious disease and increased chance of early mortality, says Stephen Lawson, former co-director of the Laboratory for Research in Gene Regulation at the Linus Pauling Institute at Oregon State University. “Insufficiencies can contribute to chronic diseases such as cancer and heart disease due to oxidative stress and free radical damage,” he notes.

Falling Short

Many people are falling through the nutritional gaps. According to the USDA, more than 90% of all Americans don’t get enough vitamin E (although actual deficiencies are very rare), 56% come up short on magnesium, 44% are below recommended levels for vitamin A and 31% for vitamin C. In addition, recent estimates of suboptimal vitamin D levels range from 50% to 70% of the adult population.

The root causes of these widespread insufficiencies vary, but “many medicines contribute to deficiencies,” says Magaziner. For example, birth control pills may increase the need for vitamins B6, B12 and C as well as folic acid; statins may inhibit CoQ10 synthesis; and antibiotics can lower levels of vitamins B and K along with probiotics, the healthy bacteria that inhabit the digestive tract.

Finding a Practitioner

Since a standard medical check-up doesn’t address nutritional issues, the best way to find out if you are facing a vitamin deficit is to speak with a healthcare professional who makes nutrition a cornerstone of their practice. Naturopathic physicians (NDs) believe in looking for the root causes of disease, including shortfalls in crucial nutrients, as part of educating patients to take better care of themselves. To find an ND in your area, visit the website of the American Association of Naturopathic Physicians at www.naturopathic.org or call 866-538-2267.
Registered dietitians (RDs) often partner with other health professionals in hospital and public health settings; some specialize in fields such as diabetes education or pediatric nutrition. Many RDs are members of the American Dietetic Association; to learn more visit www.eatright.org or call 800-877-1600. The American Holistic Medical Association represents holistic practitioners in various specialties, including nutrition; to find one visit www.holisticmedicine.org, click on the Find a Practitioner button and scroll down to the specialities list.

This may help explain drug side effects; while a statin may lower your cholesterol, the “side effect” of fatigue may actually stem from a reduction in CoQ10. “The solution may be as simple as taking a CoQ10 supplement if you’re on statins and probiotics if you’re on antibiotics,” says Magaziner.
Other factors that can deplete vitamin stores include lifestyle choices such as smoking and drinking, and food handling practices. “The transportation and storage of foods and processes such as bleaching can destroy nutrients,” says Magaziner.

Different segments of the population are susceptible to specific deficiencies. Premenopausal women often get less than the recommended amounts of iron. Vegetarians, particularly vegans, may require supplements of vitamin B12, which is found in foods of animal origin (see Supplement Savvy on page 48). Seniors may also require higher amounts of vitamin B12, and older adults often fall short on vitamin B6. In addition, research shows a decreased efficiency of one of the physiological transport mechanisms for vitamin C in seniors. “Seniors may need to consume three times more vitamin C than younger people to attain similar blood concentrations,” says Lawson.

Women who have recently given birth may need extra nutrients as well. In fact, links between nutrient deficiency and post-partum depression symptoms have been found for calcium, folic acid, iron, omega-3 fatty acids, selenium, vitamin B12 and zinc (Journal of the American Dietetic Association 9/09).

The Biggest Deficits

Among all nutrients, vitamin D deficiency and insufficiencies top the list, according to Mark Moyad, MD, director of preventive medicine at the University of Michigan. “A random blood test for vitamin D levels at a recent conference yielded such a large number of deficiencies and insufficiencies that we thought something was wrong with the lab,” says Moyad. There wasn’t.

Why such a widespread lack of vitamin D? Moyad says that several issues are at work, including the fact that there are few food sources, mainly cod liver oil and fortified milk. The main natural source is sunlight, which triggers D formation within the skin. That’s why skin cancer awareness is a double-edged sword: Sunblock reduces the risk of deadly melanoma but interferes with creation of vitamin D. Concerns over melanoma risks leads parents to limit children’s sun exposure, which could have profound long-term health effects without supplementation; deficiencies have been noted in youngsters from infancy to adolescence. People who are light-sensitive, those living in areas with limited sun exposure and those who don’t absorb fat well may also have lower-than-optimal levels of vitamin D. “And obese individuals are at higher risk of low blood levels of vitamin D,” adds Moyad.

Deficits in vitamin D, particularly among young people, may lead to health problems down the road (Journal of the American Board of Family Medicine 11-12/09). Beyond its long-known function in maintaining bone integrity, evidence suggests that the sunshine vitamin may help prevent autoimmune diseases such as multiple sclerosis and rheumatoid arthritis as well as some types of cancers, especially those of the breast, colon, ovary and prostate.

Another nutrient lacking in many diets is vitamin C. “Vitamin C insufficiencies occur because of complacency,” says Moyad. “It’s boring, it’s been around forever and it’s not new like vitamin D. Yet, no other vitamin correlates so closely to our lifestyle. When you practice unhealthy habits, you pay for it in your C level.” For example, smoking and weight gain significantly reduce vitamin C. This deficiency’s effects go beyond the individual. “Vitamin C levels are representative of the health of the US population,” says Moyad. “In fact, dietary recommendations are adjusted to allow for the smoking
population, which is not done with any other vitamin or mineral.”

A deficiency of omega-3 fatty acids may have one of the largest impacts on mortality, according to a study by researchers from the Harvard School of Public Health (PLoS Medicine 4/28/09). Low omega-3 intake was found to be responsible for 96,000 preventable deaths a year. “Omega-3 helps lower lipids and control cholesterol,” says Magaziner, noting that its benefits are now recognized by the American Heart Association. Omega-3 also acts as an anti-inflammatory and may help ease conditions such as rheumatoid arthritis.

Recommendations Defined

Knowing how much of each nutrient you need can be confusing. Several systems of dietary recommendations exist, each serving a different purpose, and government guidelines often lag behind science. “The Food and Nutrition Board of the Institute of Medicine (IOM) reviews the Dietary Reference Intakes (DRI) for specific vitamins and minerals only periodically,” says Lawson. “They don’t revise and update as new information emerges, so there’s always a lag between discoveries and recommendations.” New information must also first be validated by multiple studies.

For example, the Recommended Dietary Intake (RDA) recommends intake levels sufficient to meet the requirements of 97% to 98% of healthy individuals in each life-stage and gender group. The Food and Nutrition Board reviews and updates the RDAs every five to ten years.

The Dietary Reference Intake (DRI) from the IOM (part of the US National Academy of Sciences) was later introduced to broaden the existing RDA guidelines. Schools, prisons, hospitals and nursing homes use the DRI; so do companies developing new food products, healthcare policy makers and public health officials. Unlike the RDAs, the DRIs are not used for labeling and are lower than the RDAs.


Food labels listing the percentage of recommended daily intakes use the Percent Daily Value or “DV,” based on a 2,000-calorie diet for adults 18 and over. For example, a yogurt label listing its calcium content as containing “80%” of the daily recommended amount indicates that you need 20% more calcium to meet recommendations.

How Much Do You Need?

The problem with the RDAs is that they reflect what nutrition authorities deem the proper amounts for the population at large, but which may not reflect your unique needs. That means the goal is to find the levels of nutrients where you function optimally, says Magaziner. “For example, ‘normal’ serum levels of vitamin B12 range from approximately 200 to 900 micrograms. One person may be ‘normal’ at a B12 level of 250 but is it really best for that person’s optimal functioning?” Vitamin D is another example. Even as the Institute of Medicine considers increasing the RDI from the current 400 IU, there are studies which support intake levels of up to 5,000 IU.

Determining your current levels of nutrients can be done easily at your practitioner’s office. “A simple blood test for vitamin D (ask for the 25-OH vitamin D test, as several others also exist), vitamin C and homocysteine (a marker for B-vitamin status, including B12) will cost you very little money and can tell you a lot about your nutrient status,” says Moyad. Trial and error may be required to find the level at which you function best, taking your health profile, diet and lifestyle into account. The best way is to work with a nutritionally aware practitioner.

No one sees a return to the days of pellagra and scurvy, but that doesn’t mean nutrient insufficiencies do not still exist. Don’t let such shortfalls threaten your long-term health.

Nutritional Research Roundup

Scientists at Brigham Young University in Utah have found that increased intakes of magnesium reduced the risk of coronary heart disease in men (Journal of the American Academy of Nurse Practitioners 12/09)…Supplemental iron and folic acid reduced infant mortality by 31% among 5,000 pregnant women in Nepal, according to researchers at the Johns Hopkins Bloomberg School of Public Health in Maryland (American Journal of Epidemiology 10/09 online)…A multicenter study found that calcium and vitamin D may help protect cells in the lower digestive tract against possibly malignant changes (Cancer Epidemiology, Biomarkers & Prevention 11/09)…A European study in mice found that supplemental CoQ10 may inhibit the development of fatty liver related to obesity (Biochemical Pharmacology 10/09)…A combination of CoQ10 and omega-3 fatty acids may lower both blood pressure and heart rate in people with kidney disease, according to researchers in Australia (Journal of Hypertension 9/09)…Probiotic supplements reduced the risk of upper respiratory tract infections among children in a Croatian study (Journal of Clinical Nutrition 11/09 online)…According to Chinese scientists, folic acid supplements may reverse unhealthy blood-vessel changes in people with diabetes (The Journal of Nutritional Biochemistry 11/09 online)…A Boston-led research team found that increased intake of folic acid may lower the risk of male hearing loss by 20% (American Academy of Otolaryngology-Head and Neck Surgery Foundation, annual meeting 10/09).

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