When to Check a Client for Nutrient Deficiencies?

Highlights:

• Micronutrient deficiencies are widespread and pose a serious risk to health and longevity
• The elderly, menstruating, breastfeeding, or pregnant women, dieters, and patients with intestinal diseases and insufficient sun exposure are at an increased risk of deficiency
• Recommending preventative micronutrient testing to clients who are at an increased risk of deficiency can significantly help with their healthy longevity journey

Introduction

Micronutrient deficiencies gained attention with discussions around vitamin D and iron. Unfortunately, most micronutrients are still not routinely tested. Nutritionists and health coaches are well-positioned to highlight the risks of these deficiencies to clients and increase their motivation for sufficient intake. Sending everyone for a blood test might not be practical, so understanding which groups of clients are at an increased risk can help you identify those that will benefit the most.

Micronutrient deficiencies are very common

Vitamin and mineral deficiencies often go quietly unnoticed until the health problems become too severe and obvious. Awareness has been raised about micronutrients such as vitamin D or vitamin B12, and they are now tested more commonly. The fact remains that nearly one-third of the U.S. population is at risk of micronutrient deficiency (1) and we will go over the main reasons later in the article. Based on a report from the Centers for Disease Control and Prevention (2), the most common vitamin and mineral deficiencies in the U.S. are iron, vitamin D, and vitamins B12 and B6.

Unfortunately, milder subclinical forms of deficiencies are even more widespread and often include multiple micronutrients. For example, an estimated 20% of the world has a subclinical magnesium deficiency. In people with poorly-controlled type 2 diabetes, this number might be as high as 75% (3). Subclinical deficiencies are harder to recognize because they do not always have clear symptoms that would help clinicians recognize them. Research shows that even people that follow recommended popular diets and eat 5 daily servings of fruits and vegetables are at risk of subclinical deficiencies in vitamins D, E, and some B vitamins (4). Even sufficient fruit and vegetable intake does not cover all essential micronutrients in optimal amounts. This is why testing clients who might be at a higher risk can be so valuable.

A serious risk for longevity

It may not sound serious when a client hears that they might have lower than optimal levels of a few micronutrients. It is important to explain the connection between nutrient deficiencies and healthy longevity to your clients. Subclinical deficiencies are a risk factor for multiple chronic diseases. For example, suboptimal levels of vitamin B6, B9, and B12 are risk factors for cardiovascular disease as well as colon and breast cancer. Low levels of vitamin D contribute to osteopenia which manifests as loss of bone mineral density, and fractures, especially in the elderly (5). Micronutrient deficiencies also impact longevity directly through DNA damage, such as chromosomal breaks. They can cause mitochondrial decay and cellular aging. The scarcity of micronutrients in the body triggers a triage response where they are preferentially used for energy production to ensure short-term survival. This is at the expense of long-term health and accelerates cancer, aging, and neural decay (6).

Who is at an increased risk of deficiencies?

There are three main factors that influence the risk of nutrient deficiency. The first one is diet quality and quantity. Insufficient intake of nutrient-dense food groups such as fruits and vegetables as well as undereating are the leading causes. The second is nutrient absorption which can be influenced by intestinal health, aging, and medication use. And third is increased nutrient requirements due to physical activity and certain conditions. Below is a list of common cases where you should recommend micronutrient testing to your clients.

• The elderly

There are several intrinsic factors that make older people much more likely to not get enough vitamins and minerals. Most chronic diseases, as well as aging itself, affect the body’s ability to take in micronutrients. They have less stomach acid, which is needed to properly digest food, and less gastric intrinsic factor, which is a glycoprotein needed to absorb vitamin B12. There are also several very common extrinsic factors, such as poor appetite, trouble preparing food, difficulty chewing food, reduced enjoyment of eating, and interactions with medication (7).

• Pregnant, breastfeeding, or menstruating women

Pregnancy, breastfeeding, and blood loss due to menstruation can all contribute to iron deficiency (8). This is problematic because even a mild iron deficiency can result in iron deficiency anemia, fatigue, headaches, pale skin, anxiety, and shortness of breath (9). This is why testing iron and ferritin levels can be very beneficial for women.

• Clients with insufficient sun exposure

Vitamin D is often called the sun vitamin because it is produced in the skin when it comes in contact with the sun's ultraviolet (UVB) rays. Exposing bare skin outdoors in direct sunlight is the main way most people get vitamin D. For many clients, this does not require a lot of effort to achieve. Unfortunately, there are several cases when getting sufficient sun exposure is impossible. For example, clients that live in northern latitudes or experience large seasonal changes in sun exposure (10). Similarly, clients with darker skin tones are usually able to synthesize less vitamin D compared to lighter skin tones (11). Also, insufficient vitamin D levels can be a risk for clients that keep most of their skin covered up outdoors for religious or traditional reasons (12).

• Dieters

Clients that struggle with disordered eating or tend toward restrictive diets could be at an increased risk. Limiting food groups often results in an overall calorie reduction which can affect micronutrient intake. For example, vegans and vegetarians more often suffer from vitamin B12 deficiency because animal foods are the main source of this vitamin. Studies show that vitamin B12 deficiency may negate the cardiovascular disease prevention benefits of vegetarian diets (13).

• Clients with intestinal diseases

The absorption of micronutrients can be an issue with people suffering from intestinal diseases. Celiac disease patients typically have multiple severe vitamin and mineral deficiencies despite having an adequate intake. Similarly, clients suffering from Crohn’s disease or Inflammatory bowel disease are at an increased risk due to poor absorption (14).

Conclusion

Micronutrient deficiencies can be hard to detect because they often do not come with specific symptoms, and most vitamins and minerals are not routinely tested. Even subclinical deficiencies pose serious danger to health and longevity. If you have clients from any of the as above mentioned risk groups, you should recommend regular deficiency screening. Discovering a deficiency is the first step to fixing the underlying issue and may translate into improved health and increased lifespan.

References

1. Bird JK, Murphy RA, Ciappio ED, McBurney MI. Risk of Deficiency in Multiple Concurrent Micronutrients in Children and Adults in the United States. Nutrients 2017;9(7):E655. 10.3390/nu9070655
2. Centers for Disease Control and Prevention. CDC’s Second Nutrition Report: A comprehensive biochemical assessment of the nutrition status of the U.S. population. 2012. https://www.cdc.gov/nutritionreport/pdf/4page_%202nd%20nutrition%20report_508_032912.pdf
3. DiNicolantonio JJ, O'Keefe JH, Wilson W. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open heart 2018;5(1):e000668. 10.1136/openhrt-2017-000668
4. Calton JB. Prevalence of micronutrient deficiency in popular diet plans. Journal of the International Society of Sports Nutrition 2010;7:24. 10.1186/1550-2783-7-24
5. Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA 2002;287(23):3127-9. 10.1001/jama.287.23.3127
6. Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proceedings of the National Academy of Sciences of the United States of America 2006;103(47):17589-94. 10.1073/pnas.0608757103
7. van Staveren WA, de Groot LC. Evidence-based dietary guidance and the role of dairy products for appropriate nutrition in the elderly. Journal of the American College of Nutrition 2011;30(5 Suppl 1):429S-37S. 10.1080/07315724.2011.10719987
8. Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harbor perspectives in medicine 2013;3(7):a011866. 10.1101/cshperspect.a011866
9. Patterson AJ, Brown WJ, Powers JR, Roberts DC. Iron deficiency, general health and fatigue: results from the Australian Longitudinal Study on Women's Health. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 2000;9(5):491-7. 10.1023/a:1008978114650
10. Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. The Journal of clinical endocrinology and metabolism 1988;67(2):373-8. 10.1210/jcem-67-2-373
11. Taksler GB, Cutler DM, Giovannucci E, Keating NL. Vitamin D deficiency in minority populations. Public health nutrition 2015;18(3):379-91. 10.1017/S1368980014000457
12. Nichols EK, Khatib IM, Aburto NJ, Sullivan KM, Scanlon KS, Wirth JP, Serdula MK. Vitamin D status and determinants of deficiency among non-pregnant Jordanian women of reproductive age. European journal of clinical nutrition 2012;66(6):751-6. 10.1038/ejcn.2012.25
13. Pawlak R. Is vitamin B12 deficiency a risk factor for cardiovascular disease in vegetarians. American journal of preventive medicine 2015;48(6):e11-26. 10.1016/j.amepre.2015.02.009
14. Kilby K, Mathias H, Boisvenue L, Heisler C, Jones JL. Micronutrient Absorption and Related Outcomes in People with Inflammatory Bowel Disease: A Review. Nutrients 2019;11(6):E1388. 10.3390/nu11061388

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