Nutrient Deficiencies
Eating a rainbow of fruits and veggies is a good approach to increasing your nutrient intake. Image of colorful produce.
Last week, we focused on a few medical conditions and medications that can deplete nutrient stores, interfere with absorption, or increase nutrient needs. I also included a reference where you can look up your medications and identify any known nutrient depletions you may be encountering through the course of your medical care. If you identify some and are considering adding in supplementation, remember to review the article on supplements and nutrition tracking before you invest a significant amount of resources into addressing them.
This week, we will shift gears and look at nutritional deficiencies. Before we dive into different deficiencies and the diseases they cause, let’s pause to consider the differences between nutrient deficiencies and insufficiencies.
Through this article, I will be referring to deficiencies as disease states resulting from inadequate intake, depletion of stores, or increased loss of specific nutrients. This is not to be confused with insufficiencies which are complications of low levels of nutrients that are not severe enough to cause a disease state. It is quite common for these two words to be used interchangeably, but there are real differences.
When we begin discussing individual nutrients (in June), I will go into much more detail on each nutrient. I’ll go over what each nutrient does, where to find it in food, how much a healthy individual needs, symptoms of toxicity, and a few strategies for increasing your intake. If you can’t wait until then, check out the references at the bottom of the page.
Okay, now that I’ve clarified some things, let’s jump in shall we?
Vitamins
Image of citrus and pomegranates
Vitamin A
Inadequate intake of Vitamin A can result in several health issues.
Eye diseases and blindness - Vitamin A deficiency is the leading cause of preventable blindness worldwide. Symptoms usually begin as night blindness and progress as the deficiency worsens.
Vitamin A deficiency also leads to an increased susceptibility to infectious diseases and an increased risk of long-term complications or death from infection. This is one reason why Vitamin A is often given with vaccination in areas that routinely experience famine or malnutrition.
Additionally, low Vitamin A levels can result or contribute to thyroid disease even when other nutrients are consumed in adequate amounts. (1a)
B Vitamins
The B vitamins are a group of several different vitamins; we will take a look at each one individually:
Thiamin (B1)
The disease resulting in deficiency of thiamin is called Beriberi and comes in four different classifications based on which areas of the body are affected.
Dry Beriberi involves issues with the nervous system including muscle pain and weakness, paralysis, and burning of the hands and feet.
Wet Beriberi adds damage to the heart and blood vessels in addition to the neurological issues.
Cerebral Beriberi is often seen in people who chronically over consume alcohol. Symptoms include abnormal eye movements, instability during walking or standing, and severe mental issues including forms of psychosis and amnesia. On a personal note, I have a family member who suffers from this condition. It is irreversible and he now lives full-time in a care home. Watch that alcohol please!
Gastrointestinal Beriberi involves nausea, vomiting, and severe abdominal pain.
Thiamin is very important for multiple reasons. (1g)
Riboflavin (B2)
A deficiency of riboflavin is known as Ariboflavinosis and can cause a rash inside and around the mouth including the tongue, seborrheic dermatitis which is a moist scaly rash, growth of blood vessels on the cornea of the eye leading to issues with vision, and anemia. (1f)
Niacin (B3)
Niacin deficiency results in the condition known as Pellagra. The symptoms of Pellagra are referred to as the 4 D’s: Dermatitis from sun exposure, Diarrhea, Dementia, and Death. It is thought that endemic outbreaks of Pellagra may be responsible for the creation of the vampire myth. (1d)
Pantothenic Acid (B5)
Pantothenic acid deficiency is remarkably rare and has only been witnessed in cases of extreme malnourishment found in prison camps or through animal experiments designed to investigate symptoms. (1e)
Pyridoxine (B6)
Vitamin B6 deficiency is another uncommon condition. In these rare cases, we see neurological symptoms ranging from seizures to irritability and inflammation and ulceration of the tongue, inside of the mouth, lips, and skin surrounding the mouth. (1h)
Biotin (B7)
Biotin deficiency causes issues with hair loss, a scaly skin rash on the face and genitals, neurological issues such as depression or seizure, and lowered immune function against bacteria and fungi. On a personal note, a review of my nutritional intake over the past 2 months shows that I have had a chronically low biotin intake - perhaps this is why I’ve been dealing with perioral dermatitis off and on. More nutritional yeast is going into my daily diet to correct this, and I’m already noticing significant improvement. (1b)
Folate (B9)
Clinically low levels of folate result in megaloblastic anemia (large blood cells that don’t work very well), and can lead to spina bifida which is a defect during fetal development resulting in an incomplete formation of the brain, spinal cord, and or the tissues that surround and protect them. The March of Dimes has long worked to increase awareness of this issue and promote the use of prenatal vitamins in all women who are or could become pregnant. (1c, 2a)
Cobalamin (B12)
B12 deficiency is seen most often in vegans who do not supplement their diets with nutritional yeast or B12 supplements, the use of certain medications, or in persons with impaired absorption from other causes such as pernicious anemia or after bariatric surgery. Symptoms include megaloblastic anemia (similar to Folate deficiency), soreness and inflammation of the tongue, loss of appetite, constipation, and neurological symptoms ranging from tingling of the hands and feet all the way to dementia. (1i)
Vitamin C
You scurvy dog! Vitamin C deficiency is one of the most well known nutrient-connected diseases and is why citrus fruits such as oranges and limes were included in ship holds for long voyages. Symptoms include spontaneous bleeding under the skin, poor wound healing, loss of hair and teeth, and joint swelling. It is a disease rarely seen in richer countries, but it is not unheard of especially with picky eaters who subsist mostly on simple carbohydrate meals and avoid fruits and vegetables. (1j)
Vitamin D
Vitamin D is getting more and more attention these days due to its role in immune health, cholesterol metabolism, blood pressure, and depression. We will cover these topics more when we devote a whole week to Vitamin D in June. For now we will focus on severe deficiency which results in diseases of the bones and muscles. (1k)
Rickets is a disease of childhood when bones are developing. Without sufficient Vitamin D, bones fail to mineralize properly and become soft. This can result in bone deformity including bowed legs.
Osteomalacia is a disease of adulthood occuring after bones have fully developed. Here, low levels of vitamin D result in softening of the bones which cause bone pain and can lead to osteoporosis.
Muscle Weakness and pain can also be caused by low levels of vitamin D in children and adults without full progression to loss of bone density.
Vitamin E
Severe vitamin E deficiency is another rarity amongst humans but can result from chronic malnutrition. Symptoms are mostly neurological in nature and include issues with coordination and balance, damage to the nerves that help us sense the world around us, muscle weakness, and eye damage. Deficiency results in more intense damage in the developing nervous systems of children. (1l)
Vitamin K
Deficiency of vitamin K results in bleeding disorders where blood fails to clot. This can cause life-threatening situations especially in infants and requires immediate intervention. This is why vitamin K is routinely given to infants usually as an injection after birth. (1m)
Minerals
Minerals make their way from the soil through our foods and into us. Image of a cave.
Calcium
Low calcium intake during growth can prevent people from reaching their peak optimal bone density. This is important as after the age of 30 bone density tends to start dropping. This, along with continued or newly developed calcium deficiency after 30, increases a person’s likelihood of developing osteoporosis. (1n)
Chromium
Chromium plays many roles in the body. However, deficiency of chromium is not well documented nor understood. Theoretically, low chromium levels may result in insulin resistance and increase the likelihood of developing conditions such as metabolic syndrome, polycystic ovarian syndrome, and diabetes. (1o)
Copper
Copper deficiency is also quite rare. Symptoms include anemia that doesn’t respond to iron supplementation, low white blood cell count, osteoporosis and other bone abnormalities, loss of pigmentation of the skin, and neurological complications. (1p)
Fluoride
The only documented effect of low fluoride levels is an increase in dental cavities. This has been studied by comparing areas with naturally lower and higher fluoride levels in the drinking water. Areas with fluoride levels around 0.7 mg/L tend to have 40-60% fewer cavities than their lower fluoride counterparts. (1q)
I will address symptoms of excess fluoride along with all other nutrients when we spend a week with each one as the year progresses. I’m not ignoring these issues, but I will address them more thoroughly later.
Iodine
Iodine is needed for healthy thyroid function. Iodine deficiency is the leading preventable cause of brain damage world-wide due to this connection with the thyroid gland. Symptoms of deficiency include mental deficits, hypothyroidism, goiter (a swelling of the thyroid), and growth/development abnormalities. (1r)
Iron
Iron deficiency is a large cause of anemia (lack of blood cells or poorly functioning blood cells). Symptoms of iron deficiency anemia include: fatigue, rapid heart rate, palpitations, and excessive heavy breathing with exertion especially with an increase in elevation such as climbing stairs. (1s)
Magnesium
Severe deficiency of magnesium is uncommon due to the prevalence of it in animal and plant foods, but inadequate intake levels are quite common. Symptoms of severe deficiency include a decrease in calcium and potassium levels, sodium retention, nervous system and muscle symptoms including spasms and tremors, loss of appetite, nausea, vomiting, and personality changes. (1t)
Manganese
Most of our information regarding manganese deficiency is from animal studies and clinical data involving children receiving 100% tube feeding. Symptoms “include impaired growth, impaired reproductive function, skeletal abnormalities, impaired glucose tolerance, and altered carbohydrate and lipid metabolism.” (1u)
Molybdenum
Another extremely rare deficiency. This condition has only been documented once and symptoms included disruption of amino acid metabolism resulting in rapid heart and respiratory rate, headaches, night blindness, and coma. (1v)
Phosphorus
Phosphorus is a mineral that our bodies hold onto with all their might. This results in fewer cases of deficiency, but when they do happen they can be life threatening. Symptoms include: “loss of appetite, anemia, muscle weakness, bone pain, rickets (in children), osteomalacia (in adults), increased susceptibility to infection, numbness and tingling of the extremities, difficulty walking, and respiratory failure.” (1w)
Potassium
In addition to iron deficiency, vitamin D deficiency, Folate, and B12 deficiency, low levels of potassium in the blood is one of the more common deficiencies I see in clinical practice. Symptoms include: “fatigue, muscle weakness and cramps, and intestinal paralysis, which may lead to bloating, constipation, and abdominal pain.” Long-term deficiencies can lead to hypertension, heart palpitations, and potentially deadly arrhythmias. (1x)
Selenium
Selenium deficiency is uncommon but when mild can result in reduced ability to adapt to stress. In chronic cases, selenium deficiency leads to heart damage that is potentially deadly as in Keshan disease. In areas of Tibet and surrounding regions Keshan-Beck disease is the result of selenium deficiency and can produce stunted growth leading to dwarfism, and osteoarthritis. (1y)
Sodium
Here in the US, we are much more concerned about too much sodium (in the form of table salt and processed foods) than low levels; however this can still occur. Sodium (along with potassium) is important in the function of our nervous system. Where Potassium is like the positive side of a battery, Sodium is the negative side. These two nutrients in the right proportion are very important for every function of our bodies. Low sodium known as hyponatremia occurs after diarrhea, nausea, or excessive sweating and is why we turn to electrolyte replacement during these times.
Low sodium presents as “headache, nausea, vomiting, muscle cramps, fatigue, disorientation, and fainting.” If untreated at this stage, hyponatremia can progress to swelling of the brain, seizure, coma, brain damage, and death. (1z)
Zinc
“ The symptoms of severe zinc deficiency include the slowing or cessation of growth and development, delayed sexual maturation, characteristic skin rashes, chronic and severe diarrhea, immune system deficiencies, impaired wound healing, diminished appetite, impaired taste sensation, night blindness, swelling and clouding of the cornea, and behavioral disturbances.”
Milder cases of zinc deficiency result in developmental delays, physical growth delays or loss, and an increased risk of infection. (1aa)
Other Essential Nutrients
Choline
Choline is found most abundantly in animal products but also can be found in smaller amounts in foods such as peanuts, cauliflower, and coffee. It is an often overlooked nutrient, but it still has an important role to play in our bodies.
Symptoms of deficiency include the development of fatty liver disease and muscle damage. (1bb)
Fiber
We will be going into this nutrient in great depth soon, but for now know that decreased levels of fiber intake cause constipation and disrupt the flora of your intestines. If you have heard anything about the benefits of probiotics, know that without adequate fiber, you are risking developing all of the symptoms probiotics have been studied to help with, inflammatory bowel disease, diabetes, arthritis, depression, cardiovascular disease, fatty liver disease, and more.
Essential Fatty Acids
While I don’t promote a ketogenic diet due to the potential for muscle wasting and cardiovascular disease, fat is our friend. When we don’t get enough of our essential fatty acids: Linoleic (omega-6) and alpha-linolinic (omega-3) we develop unpleasant symptoms such as “a dry scaly rash, decreased growth in infants and children, increased susceptibility to infection, and poor wound healing.” (1cc)
Applications
Now that you have this information, what’s next? Image of an arrow pointing to the right.
My intention with this brief overview of significant nutrient deficiency is to help you get a better understanding of just how important all these vitamins and minerals really are. Some nutrients are less likely to be issues if you are eating food and do not have significant medical issues. Others like iron, vitamin D, potassium, B12, essential fatty acids, fiber, calcium, and choline are considered nutrients of risk as deficiencies are not that uncommon.
When we review each nutrient in detail later this year, you will see that insufficient and toxic (too high) levels of nutrients can also have functional health impacts even if they're not severe enough to result in disease.
Each nutrient is referenced below, and you can learn so much more about them and really dive deep.
Again, before jumping to purchasing supplements, make sure you know how to evaluate your dietary intake, how to choose safe and effective options, and contact your medical team for an evaluation and personalized advice. Remember, if your primary care doctor doesn’t seem to have options for you, consider asking for a referral to a dietician or nutritionist, and if this isn’t an option, seek out one on your own. You may need to pay out of pocket, but once you feel comfortable and confident with the information, you can take charge yourself.
Next Week
Next week we will jump into the topic of organic vs non-organic foods. We will talk about which foods to prioritize purchasing as organic, which ones typically have lower pesticide levels, and we will talk a bit about sourcing local foods and growing some of your own even if all you have is a single window sill at your disposal.
Until then, to our health!
References:
Linus Pauling Institute Micronutrient Information Center
https://lpi.oregonstate.edu/mic/vitamins/vitamin-A#deficiency-related-disorders
https://lpi.oregonstate.edu/mic/vitamins/biotin#deficiency-signs-symptoms
https://lpi.oregonstate.edu/mic/vitamins/pantothenic-acid#deficiency
https://lpi.oregonstate.edu/mic/vitamins/riboflavin#deficiency
https://lpi.oregonstate.edu/mic/vitamins/vitamin-B6#deficiency
https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12#deficiency
https://lpi.oregonstate.edu/mic/vitamins/vitamin-C#deficiency
https://lpi.oregonstate.edu/mic/vitamins/vitamin-D#deficiency
https://lpi.oregonstate.edu/mic/vitamins/vitamin-E#deficiency
https://lpi.oregonstate.edu/mic/vitamins/vitamin-K#deficiency
https://lpi.oregonstate.edu/mic/minerals/chromium#deficiency
https://lpi.oregonstate.edu/mic/minerals/copper#deficiency
https://lpi.oregonstate.edu/mic/minerals/fluoride#deficiency
https://lpi.oregonstate.edu/mic/minerals/magnesium#deficiency
https://lpi.oregonstate.edu/mic/minerals/manganese#deficiency
https://lpi.oregonstate.edu/mic/minerals/molybdenum#deficiency
https://lpi.oregonstate.edu/mic/minerals/phosphorus#deficiency
https://lpi.oregonstate.edu/mic/minerals/potassium#deficiency
https://lpi.oregonstate.edu/mic/minerals/selenium#deficiency
https://lpi.oregonstate.edu/mic/minerals/zinc#deficiency
https://lpi.oregonstate.edu/mic/other-nutrients/choline#deficiency
https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids#deficiency
Mayo Clinic:
