Are you getting enough vitamins and minerals from your diet? Do you even know exactly what a vitamin is? Or how many there are? The answer to those questions might surprise you.
In this episode, I will take you into the world of micronutrients, specifically vitamins, to help you understand their essential role in human health. I explain the fascinating history of vitamin discovery and explore the prevalence of micronutrient deficiency in the United States.
I explain the various functions of vitamins, their naming conventions, and concepts like provitamins. I elaborate on the 5 key roles that vitamins play, including their function as coenzymes, electron donors and acceptors, antioxidants (similar but different to the last point), and hormone-like substances. Furthermore, I lay out the [primary and secondary] causes of vitamin deficiency, elaborate on the stages of deficiency, as well as the dangers of self-diagnosis.
Finally, I go into the significance of nutritional assessments for population-wide eating patterns and nutrient intakes, as well as how multivitamins can reduce the risk of nutrient deficiencies. We'll discuss the limitations of multivitamins and the importance of using them as an adjunct to a whole-food diet (in brief, as this episode is not about multivitamins or supplements).
Be sure to subscribe for future episodes covering specific nutrients and strategies for achieving optimal nutrient adequacy.
Are you getting enough vitamins and minerals from your diet? Do you even know exactly what a vitamin is? Or how many there are? The answer to those questions might surprise you.
In this episode, I will take you into the world of micronutrients, specifically vitamins, to help you understand their essential role in human health. I explain the fascinating history of vitamin discovery and explore the prevalence of micronutrient deficiency in the United States.
I explain the various functions of vitamins, their naming conventions, and concepts like provitamins. I elaborate on the 5 key roles that vitamins play, including their function as coenzymes, electron donors and acceptors, antioxidants (similar but different to the last point), and hormone-like substances. Furthermore, I lay out the [primary and secondary] causes of vitamin deficiency, elaborate on the stages of deficiency, as well as the dangers of self-diagnosis.
Finally, I go into the significance of nutritional assessments for population-wide eating patterns and nutrient intakes, as well as how multivitamins can reduce the risk of nutrient deficiencies. We'll discuss the limitations of multivitamins and the importance of using them as an adjunct to a whole-food diet (in brief, as this episode is not about multivitamins or supplements).
Be sure to subscribe for future episodes covering specific nutrients and strategies for achieving optimal nutrient adequacy.
Hello everyone, my name is William Wallace. I will be your host today as we take an introductory look into micronutrients, specifically, vitamins, what they are– that is, how do we define them, how it was the process of vitamin discovery that catapulted nutrition science from more of an observational science to experimental one, and their relationship with health and disease. I’ll also be going through some of the literature describing the prevalence of micronutrient deficiency and inadequacy status in the United States. This particular episode may not cover many flashy protocols to resolve insufficient nutrient status of individual nutrients, as there are so many to cover that we could be here for a very very long time. At the same time, I believe this first episode will be a must listen to for people who intend to listen moving into the future, as here we’ll lay the groundwork for understanding importance of micronutrients, important definitions that you may not have heard elaborated upon before and the prevalence of inadequate micronutrient intakes. future episodes will cover individual nutrients in greater detail with as much practical takeaway possible. With that being said, I won’t go too detailed into the history of vitamin discovery in this episode that is something you are interested in then please go to the YouTube channel and leave . Before going further, I’d like to read a supplement company whose mission is to empower individuals to take control of their health by providing nutraceuticals with powerful therapeutic applications for the improvement of physical, mental and social well-being. Altipure was first conceptualized in 2021 with several goals in mind, but one primary goal stands above the rest We wanted to produce product options in the general health sector that are as effective and quality as possible. Embedded in Altipure's values are a commitment to science, advancement, health and integrity. Our formulas are put together by combing through published research on nutrients and quantities evaluated for their benefits in clinical research. We spare no expense in sourcing the highest grade ingredients in terms of quality, potency and purity. Altapure also supports research organizations and endeavors to drive progress in the health sciences and to support the next generation of health professionals. At Altapure Health, we believe that our best self is our healthiest self. Right now, altipure has a multivitamin and a B complex for sale, with more products coming down the pipeline.
Dr. William Wallace:Here's where I have to be fully transparent, in that I have financial incentive in this brand. I am, in fact, a co-founder and I also co-developed the multivitamin along with Dr Erick Serrano, for those that do know him. Those that know me are aware that research and development, specifically product development, is my strong suit, at least I like to think so. I really do believe this is one of the more unique multivitamins on the market and it did cost us a lot of money due to develop, due to the quality and forms of the chosen vitamins and other constituents in the product. But we also decided to make this as widely available to the consumers possible by lowering the retail price. So I do hope that you'll give it a try. Right now, it is exclusively available on Amazon until the website is finished, and there should be a link to the multivitamin in the show notes wherever it is. You're listening. If you do decide to give it a try and you do like it, please do me a favor and leave us a positive Amazon review. Allow us to contribute positively to your daily nutritional intake by providing you with the best nutraceuticals that science can offer. Now moving into it.
Dr. William Wallace:Nutrients are essential to normal physiological function in microorganisms, animals and humans. From nutrients we don't synthesize the necessary amounts to support normal physiological functioning. Therefore, we need to take in these nutrients from the external chemical environment and we refer to these nutrients as essential nutrients. Among these essential nutrients are vitamins and minerals. However, this episode is going to put more of an emphasis on vitamins, with the mentioning of minerals throughout. Obviously, that's going to come toward the second half of the episode, when we get into nutrient inadequacies. Unlike protein, carbohydrates and fats, vitamins do not serve structural functions, and breaking them down or metabolizing them does not provide any meaningful energy, at least not directly. Rather, they have functions that are very specific and, as such, we only require them in very small amounts, hence micronutrients. Now, prior to the discovery and defining of vitamins this would be during the 19th century and that would be the 1800s The consensus among physiologists was that food was a source of only four types of nutrients, that is, protein, fat, carbohydrate and ash, which collectively account for nearly 100% of the mass of food.
Dr. William Wallace:By the beginning of the 20th century, there were four major diseases linked to different types of diet or eating styles, and those would be scurvy, berry, berry, rickets and polygra. You may be able to add a fifth, and that would be night blindness. By 1900, it had become apparent to some that two or three of these could be cured by dietary changes. However, at the time, germ theory, which suggested that all diseases were caused by microorganisms like bacteria, fungi and viruses that was the popularly held belief in the medical field. Most people in the very early 1900s believed that all disease was due to the presence of something harmful or undesirable, as opposed to the absence of something beneficial like micronutrients found in food.
Dr. William Wallace:There were two key realizations for the end of the 19th century that led to the concept of a vitamin and those triggered a revolution in nutrition science. One, there was an idea that food is a source of many nutrients. And two, insufficient intake of these nutrients can cause disease, even very predictable disease states at times. These realizations led to three major forces that led to the emergence of nutrition science as we know it today. Those three things were one, which is a bit redundant here, but the recognition that certain diseases were tied to diet. Two, the use of defined diets for experimentation. What I mean by that is by using diets of a defined composition where the chemical composition could be tested and quantified. Then researchers could prepare the same diets over and over again to yield comparable results and thus repeatability in nutritional experimentation that became possible. For the first time, it was defined diets that actually propelled nutrition science into more of an experimental science. The third of these major forces was the development of appropriate animal models. The use of animal models that were appropriate to diseases or physiological process of interest in human medicine made possible studies that would not be able to be conducted in or on humans. It was the use of animal models that led to the discovery of every vitamin as well as metabolic functions of all the vitamins. So, to recap, the three major forces that are responsible for the emergence and development of nutrition as a scientific discipline were realizing that diet was tied to certain diseases, the use of defined diets for experimental research and the development of appropriate animal models.
Dr. William Wallace:There was a period of about two decades, between 1890 and 1910, where very crucial animal studies were conducted, revealing two key insights that led to the actual discovery of vitamins. Those were one, that there were substances in diet that were not protein, fats or carbohydrates that prevent disease, and two, food contained what were called at the time accessory factors. These were compounds animals seemingly needed for growth, repair and maintenance functions. At the time it wasn't known if accessory factors was the same compound or groups of compounds that were needed to prevent diseases and promote normal growth and maintenance functions. But it was those two insights that led to the concept of a vitamin proposed in 1906 by a Dutch physician and professor, christian Eichkman I'm probably butchering that and the vitamin theory. That's a vitamin spelled with an E at the end of it. So vitamin just tacked on with a knee. This was proposed by Polish chemist Kazmyr Fonk in 1912, when he also proposed four different vitamins.
Dr. William Wallace:While developing the vitamin theory, kazmyr Fonk had determined that a vitamin later come to be known as thiamine, that's vitamin B1. It had an organic nitrogenous base and therefore an amine group on it and that's a derivative of ammonia. He decided to create a term generalizing from this finding and decided on vitamin, again with an E at the end of it. A combination of vital meaning pertaining to life and amine gives vital amine condensed. That became vitamin. This happened during a time before any of the vitamins had officially been isolated and given names as we know them today.
Dr. William Wallace:Actually, the first four vitamins proposed by Fonk were the anti-baribary vitamin, which we now call thiamine, and that again is vitamin B1. The anti-ricot vitamin, which we now call vitamin D. Vitamin D prevents the development of rickets in children. There was the anti-scurvy vitamin, which we now call vitamin C escorbate. This vitamin C is short for anti-scorbutic, reflecting vitamin C's ability to prevent scurvy. The last of Fonk's vitamins was the anti-palegrovitamine, which we now know as vitamin B3, and that's niacin. Fonk's vitamin theory paper allowed etiologies of diseases to be looked at through a different lens without being constrained by the popularly held germ theory at the time. Like I had mentioned before, germ theory assumed that something like the presence of microorganisms were driving most disease states, and that tended to look past the absence of something like a nutrient being causal to disease progression. It was 1920 when the E was dropped off vitamin to give us vitamin after it became clear that not all of these compounds being explored had an immune group on them.
Dr. William Wallace:The term vitamin has been defined several different ways, but for the purpose of this episode and forthcoming episodes, we're going to be using an operating definition of a vitamin that has five key parts. One a vitamin is a compound distinct from proteins, fats and carbohydrates. Two, it's a natural component of food, usually found in small amounts. Three, it's essential, usually in small amounts, for normal physiological function. This includes maintenance, growth and development processes. Four, it's not synthesized by the host, that's us in amounts needed to meet those physiological needs. And five, it prevents a specific deficiency syndrome or disease when it's absent or not being utilized. That definition is not at all without limitations.
Dr. William Wallace:As we go forward into this broadcast and in forthcoming broadcasts on specific vitamins, it's important to keep in mind the two major caveats to this particular vitamin definition. And that's one some compounds are vitamins for one species but not for others. For instance, vitamin C, that's a big one that can be synthesized by most animals besides humans, non-human primates, guinea pigs and some avian species. For those of us and the species that cannot synthesize vitamin C, it is an essential vitamin. For animals that can make enough vitamin C for their function, it's not considered a vitamin at all. The second caveat to the vitamin definition we'll use is that some compounds are only vitamins under very specific dietary or environmental conditions. Take, for example, vitamin D. Only individuals or livestock raised in indoor confinement without sufficient ultraviolet light exposure required dietary sources of vitamin D.
Dr. William Wallace:When it comes to the actual naming of vitamins or vitamin terminology, they were mostly given their naming convention and familial designation based on the history of their discovery, in other words, conditions in which they were found, and the researchers who discovered them played large roles in how they were named. Also, the chronology of their discovery, that is the order in which they were discovered. That's a combination of the compound being isolated and having its structure fully determined. For example, by the time vitamin D was isolated and its structure determined, vitamin C had already been classified. Then you have the concept of the B complex, which was an interesting development that came about because several different compounds that we now know of as B vitamins had been mistaken for the same compound in yeast at one point in time. As time went on, it became apparent that there were several separate compounds that were just lumped together as part of the same water soluble complex, and that is the B complex. That is a very short and oversimplified explanation of generally how most vitamins got their individual names.
Dr. William Wallace:As of now, there are 13 families of compounds that we call vitamins. You know these as vitamins A, c, d, e, k, all the B vitamins and so on In some cases, but not all. The name you're most familiar with is actually a generic descriptor for a family of compounds that are chemically related and also share similar metabolic activity. For example, vitamin E is a family of compounds also known as tochochrominols, and consists of eight different vitamin E parent compounds. That's four different tocoferols, alpha beta gamma delta tocoferol, and four different tocotrientols That's the same thing alpha beta gamma delta toco trientol.
Dr. William Wallace:The term vitaminers is an important one because it's used to describe compounds that fall in the same vitamin family, like is the case for the vitamin E family of vitaminers. The 13 vitamin families collectively comprise two to three times the number of relevant vitaminers. In other words, if you take all the obvious vitamins that you've heard of A, c, d and so on, add in the vitaminers as part of each of these families, and what you effectively end up with is some are around three times more vitamins than you may have been initially aware of. Another term that's important to address and describe is a provitamin. A provitamin is a compound that's not a vitamin until ingested, but once metabolized, it can be converted into a metabolically active vitamin, and the best example of this is the carotenoid beta-carotene, which is an orangish red plant pigment that converts into vitamin A at a certain rate when ingested. That will certainly come up in future episodes, especially when dedicated to vitamin A.
Dr. William Wallace:Just a bit ago I gave an actual working definition for vitamins that consisted of five parts. Now I'll give the five physiological functions that the vitamin families and their respective vitaminers serve. Generally, and this is in no particular order, one vitamins act as coenzymes, meaning some enzymes need a specific vitamin, usually a vitamin metabolite, to bind to it so that it can catalyze a reaction, in other words work properly. Most vitamins act as coenzymes, but not all coenzymes are vitamins. The second function of several vitamins is that they act as electron donors and acceptors. For example, vitamin E can donate an electron to neutralize free radicals, at which point vitamin E becomes what we call oxidized. Vitamin C can then donate an electron to vitamin E to convert it to a reduced state, meaning vitamin E acts as an electron acceptor in this case. And then you have vitamin C at that point becomes oxidized in the process because it donated or lost an electron.
Dr. William Wallace:The third function of most vitamins is that they act as antioxidants. Now this has a bit to do with the last point of vitamins being able to donate or accept electrons is that can be considered a function of what we call a direct antioxidant. However, the most basic definition of an antioxidant is a compound that prevents, delays or reverses the oxidation of another compound, and this can be accomplished either directly or indirectly. A fourth function of a vitamin is the ability of some of them to function similar to hormones, meaning a vitamin can be taken up or made, as is the case with vitamin D, by one type of cell in the body, where it's broken down into metabolites, and then those metabolites are then released to affect tissues or cell function in another part of the body. The primary difference is that most vitamins are taken in from the external environment, where a true hormone is manufactured inside the body, although vitamin D does function in this way, as I just described. Lastly, vitamins are effectors of gene transcription. Gene transcription is the first step in the process of gene expression, where a DNA sequence is used to make mRNA.
Dr. William Wallace:The first half of the 1900s that was an exciting period in nutrition science because all major vitamin families had been discovered before 1950. Now, does that mean that all vitamins in the world have been discovered? Maybe it does, maybe it doesn't. There are several compounds that fulfill what we would call vitamin-like roles. Choline is one example. L-carnitine is another example. Whether or not these things are actually called vitamins at some point in time may come down to whether the definition of a vitamin is reinterpreted, which we really won't get into further right here Now.
Dr. William Wallace:The second half of the 1900s was largely characterized by new information regarding the use of vitamins to improve human health and animal health, as well as optimizing efficiency and the nutrient content of food. This work revealed that many vitamins worldwide are not being consumed in concentrations high enough to support all physiological needs and or stave off disease, due to what we call hypovitaminosis, meaning a state of inadequate levels of a particular vitamin in the body. This can be a state of insufficiency or, worse, deficiency. Both of these words mean different things. When discussing vitamin and mineral concentrations in the body, hypovitaminosis means there is an inadequate level of one or more vitamins in the body, based on criteria that is typically set by the National Academy of Sciences, engineering and Medicine's Health and Medicine Division, so the National Academy of Medicine. This was formerly known as the Institute of Medicine, before joining the other academies of science in 2015.
Dr. William Wallace:Historically, the primary criterion used to set vitamin insufficiency levels was the threshold of vitamin intake at which one would reduce their risk for specific nutrient related disorders. For instance, the sufficiency threshold set for vitamin D was established as the minimum amount of vitamin D that's needed to prevent metabolic bone disorders like rickets in children or osteomalacia in adults. If you were to drop under that threshold by just a small amount, you would be in a state of what we call insufficiency, which is not quite as bad as being in the state of deficiency. However, it might mean that you are on your way toward a true deficiency, if not rectified by vitamin intake. A state of insufficiency has its own range between deficiency and sufficiency, below which you wind up in a state of deficiency. Obviously, deficiency means that you are not in supply of enough of a certain vitamin to meet your needs for either disease prevention or specific regulatory processes, or both.
Dr. William Wallace:It's important to note that vitamin deficiency is different from disease signs or functional impairments that may be caused by a vitamin deficiency. In other words, disease symptoms are not the same thing as a vitamin deficiency, but a vitamin deficiency may be the cause or effect disease symptoms or functional changes in the body, but it's important to be able to separate those into different things and then assess their relationship when evaluating deficiencies. The early stages of vitamin deficiency are what we call subclinical, and those can really only be determined by biochemical indicators or biomarkers, typically through testing blood or serum and assessing one or several markers together. This subclinical stage is usually characterized by a depletion of vitamin stores and changes happening at a cellular level. It can be difficult to detect without biomarker testing because subclinical deficiency symptoms for many vitamins and minerals tend to be nonspecific and those include things like fatigue, irritability, brain fog, aches, pains, weakened immunity, etc. If a subclinical deficiency is not corrected it can progress into a clinical deficiency and in many cases that would be more obviously observable because there would be functional defect present in the form of possibly a more specific symptom that's usually has to be observed by a clinician. For instance, high-level muscle weakness or tingling sensations in the extremities can be caused by a vitamin B1 deficiency, either being or preceding berry berry. We'll touch more on specific signs of vitamin deficiency in upcoming episodes where individual vitamins are explored.
Dr. William Wallace:It's been suggested that although clinical deficiencies are not very prevalent in the United States, that marginal vitamin deficiencies may actually affect up to 31% of the population. Some people think that that's a conservative estimate and I fall into that group Approximately 15% of children and up to 20% of people who we would classify as dieters or those being on extended hypochloric diets in the United States may be affected by at least one marginal vitamin deficiency vitamin or mineral deficiency, i should say. Studies conducted around data collected by the National Health and Nutrition Examination Survey, also called NHANES, suggests that 50% of Americans have inadequate intake of at least one vitamin. However, inadequate intake, as noted in a survey, does not necessarily indicate a marginal deficiency, though it can lead to one. Vitamin status is defined as the balance between one's biological need and vitamin supply, usually marked by body stores.
Dr. William Wallace:It's important to note that the early perspective or way of looking at vitamin status was that a lack of any obvious signs or symptoms of clinical manifestations meant good nutrition status. Of course, now we know that this perspective does not always consider vitamin stores, and it may overlook the nutritional needs of someone who's experiencing what we call that subclinical deficiency. Therefore, an updated perspective on nutritional adequacy should focus on the intakes of nutrients needed to maintain normal physiological functions, as well as preventing deficiency syndromes and diseases, and not just focusing on the absence of observable clinical symptoms. You also have to consider what might be best to optimize somebody's function and not just what is needed to prevent or correct a deficiency or inadequacy. In many cases this would have us focusing on our body's storage pools of vitamins and minerals. However, if we're talking specifically about testing, there are some limitations there that we'll explore in upcoming episodes.
Dr. William Wallace:It's also very important to note that, although hypovitaminosis of sufficient magnitude can be causally related to clinical symptoms, someone might be experiencing that our understanding of cause and effect relationships between specific vitamin deficiencies and specific clinical manifestations that they bring about that's not entirely complete. In some cases it can be obvious, as is the case with polygrain niacin deficiency. In other cases, cause and effect relationships they're not so obvious. Take, for instance, vitamin A. It's actually been suggested that over 90% of what we know about the effects of vitamin A that may only actually contribute to a very small percentage of all of the functions that vitamin A actually serves in the body. So we have a long way to go as far as what we truly know about vitamins and their relation to all diseases.
Dr. William Wallace:So when does vitamin deficiency occur? Vitamin deficiency occurs when either of the two factors that make up vitamin status are thrown at a balance, that is, shortages in vitamin supply and or an increase in the need for one or more vitamins. An example of the latter would be athletes who consume diets high in carbohydrates possibly needing more vitamin B1, that's thiamine, as need increases proportionally to carbohydrate ingestion to a point. If deficiency of a vitamin occurs due to a shortage of internal supply or failure to ingest adequate amounts of a vitamin, we call this a primary deficiency. If deficiency arises due to an inability to utilize or absorb a vitamin, we call this secondary deficiency. This can be caused by a condition like your dual bowel syndrome, which might limit the absorption of select vitamins and nutrients. This can also be caused by alcoholism, which tends to lower the utilization of many vitamins. Not to mention, people who struggle with alcoholism tend to take in less vitamins overall, thereby being at a greater risk for a primary deficiency as well as secondary deficiency.
Dr. William Wallace:It's important for me to come back to the point that true vitamin deficiency is not very common in developed countries like the United States or many European countries, but, like I noted earlier, marginal deficiencies and inadequate vitamin intakes do affect a large and noteworthy percent of people all over the world. There are factors that contribute to primary deficiency that we tend not to think about or consider if we don't fall into a particular demographic, where that's relevant. For instance, socioeconomic status is often cited as a major driver of primary deficiency, as well as a perceived barrier to sound nutritional practices by people that fall into this group. This includes people in low to middle-income countries, but also people living in developed countries who are lower in economic status. There was a popular systematic review that was published in 2014, i believe, looking at two decades of data collected in Europe from 1990 to 2011, and they demonstrated that low socioeconomic status most greatly impacted vitamin D and vitamin C intakes, compared to all the vitamins.
Dr. William Wallace:Diets of people in low socioeconomic standing tend to be what we call energy-rich but nutrient poor, meaning low in fruits and vegetables, low in high-fiber foods, fish and so on. Interestingly, obesity also disproportionately affects people living in poverty in developed countries like the United States, but disproportionately affects people of higher economic standing in less economically sound countries. Why is it important to point out obesity and poor nutrient status in less economically fortunate people in the United States? Because this creates what we call a double burden of malnutrition, that is, a state of energy excess coupled with a state of inadequate nutrient status. That can be disastrous to health, especially as that dual state creeps its way towards diabetes in an individual. Low socioeconomic status can also contribute to limited nutritional access due to several factors, one of which is a lack of knowledge about sound nutritional practices. We can also consider people with chronic conditions who live alone. They might be a part of that demographic. They also may be more likely to consume foods that take less preparation time. Such foods would be more likely to provide inadequate nutrition from a micronutrient standpoint.
Dr. William Wallace:Other causes of primary deficiency include dietary preferences. This is what we call poor food habits. Poor food storage, processing and different cooking methods can also lower the nutrient content of food. Eating disorders, including anorexia or bulimia, food trends like fad diets that cause you to cut out certain foods, or regular fasting can drive primary deficiency. Those things are common place these days. Causes and drivers of secondary deficiency include poor digestion, malabsorption, as can be the case if someone has a gastrointestinal related disorder, diarrhea, an infection affecting the intestines, and so on. Impaired nutrient utilization can be a driver of secondary deficiency. This can be the case in people taking certain medications or in people who are chronic alcohol users. An increased need for vitamins light can be the case when dealing with an infection or in women who are pregnant, can be causes of secondary deficiency. Lastly, increased vitamin excretion This can be the case in breastfeeding women. This can also happen in athletes who lose vitamin through excessive sweating.
Dr. William Wallace:I must mention that vitamin deficiencies should not be self-diagnosed. That's important. If you think that you may be affected by a true deficiency, or even a marginal deficiency, it's important to talk to your primary health care practitioner, as they should be the ones actually giving you a diagnosis. Deficiency can usually be diagnosed through a three-step analysis that includes, firstly, making connections between signs or symptoms of possible deficiency with signs and symptoms of deficiency that have been reported in scientific literature. It helps to also consider demographic factors and relevant environmental predictors of deficiency as well. Second would be the use of appropriate clinical biomarkers to find either obvious signs of deficiency or to exclude the possibility of other things.
Dr. William Wallace:For instance, testing plasma or serum levels of some vitamins, like vitamin C, are usually informative enough to assess status. This is partially the case for vitamin C, because vitamin C is not stored in the body in large quantities. Serum levels of vitamin D, specifically in 25 hydroxy vitamin D, are also good indicators of that vitamin status in the body. But not all plasma or serum measures are good direct markers of vitamin and mineral status. For instance, circulating levels of things like vitamin a, calcium, zinc, magnesium. Those tend to be poor indicators of nutrient status in the body. In addition, there's no single marker that really accurately captures captures iron status. Typically you have to look at several different markers together to formulate an accurate idea as to what Iron status looks like in the body.
Dr. William Wallace:Now sometimes if a true deficiency is present, then a serum measure like that of vitamin a can be reflective of a true deficiency. Biomarkers not readily available for every nutrient and some of them are affected by things like inflammation or infection, so it's important to keep that in mind. Kidney function in old age Those can also affect biomarker readings. The third step in the analysis would be to monitor responses to treatment. That is, if signs and symptoms and biomarkers point in the direction of one or more vitamins and minerals that need to be administered, then the administration of those things should in theory start to resolve symptoms. Sometimes this happens very rapidly and Sometimes not so immediately, depending on the severity of deficiency and the particular nutrient.
Dr. William Wallace:It's important to note here that just administering vitamins Will not always stress underlying causes of deficiency. I Say causes because they're usually multiple when it comes to a true deficiency in the real world outside of research setting. For example, vitamin a deficiency could be caused by multiple other reasons, like zinc deficiency. Zinc is required for binding vitamin a to transport proteins in the body. Vitamin a Deficiency can be caused by not getting enough protein. One's diet dietary protein is needed to make proteins that transport vitamin a and so many other vitamins throughout the body.
Dr. William Wallace:Nutrient deficiencies tend to be interrelated and do not typically happen in isolation outside of the laboratory setting. Root causes must be addressed to sustain prevention of any vitamin or mineral deficiency. Groups who tend to be the most vulnerable to or most likely to experience deficiency include infants, children and adolescents, elderly people, people who follow a vegetarian or vegan-style diet, chronic dieters, smokers, alcoholics, individuals with infection of some sort, people who are of lower socio-economic status, sometimes referred to as food insecure people, which is defined as a lack of consistent access to enough food for every person in a given household to sustain adequate nutrient status, in other words, a diet lacking in quality and or quantity. Food insecurity is highly correlated with financial status, but also one's level of education about nutrition. Other groups that are at risk for Deficiency, and some of the more prevalent and important ones to mention would be women who are pregnant and breastfeeding. We're going to go over specific nutrient requirements needed for some of these groups in later episodes, when we dive into detailed breakdowns of specific micronutrients.
Dr. William Wallace:Now, it is reasonably agreed upon that eating an energy rich but nutrient poor diet, of course, together with physical inactivity, increases one's risk of disease, including type 2 diabetes, cancer, heart disease, neurodegenerative disease and so on. According to the US Department of Health and Human Services and the US Department of Agriculture, up to one half of American adults have at least one chronic condition that is preventable. Of course, nutrition cannot prevent or cure all conditions, but it certainly plays a role in the development management of many conditions. Many Americans are clearly exceeding energy needs, yet failing to meet essential vitamin and mineral needs. This is evidenced by reporting from the CDC and the Harvard School of Public Health, who planted up to 70%, and possibly a bit More, of American adults are considered at least overweight, but overweight and obese. In addition to that, the 2020 2025 dietary guidelines for Americans suggest that 90 and 80 percent of Americans are not getting enough fruits and vegetables respectively. That is a 10% increase and people not getting enough vegetables and a 5% increase in people not getting enough fruits, compared to the 2015 2020 dietary guidelines for Americans report. It comes as no surprise, then, that nutrient intake assessment data collected from US residents for the past few decades has suggested a high prevalence of micronutrient inadequacies.
Dr. William Wallace:Nutritional assessments in populations are usually done by measuring nutrient intake through dietary surveys and then comparing the mean intake with age and gender specific nutrient requirements, although it's more difficult to do when collecting large data sets that are attempting to be representative of the population. You have biochemical indicators of deficiency. Again, that's usually in the form of blood work. That is sometimes used in conjunction with nutritional surveys to provide more reliable and objective measures of nutrient status, at least in comparison to surveys which do not tend to be highly reliable when left on their own. The big survey that is conducted in the United States to get an estimate of nutrient exposures in the US population is Conducted by the National Center for Health Statistics and is called the National Health and Nutrition Examination Survey, also called NHANES for short. Like I had just mentioned a bit ago, the National Center for Health Statistics is part of the CDC, which operates under the US Department of Health and Human Services. The national surveys are designed to assess the general health and nutrient status of the average, but we call non institutionalized Americans, so it's meant to be representative of the normal US population. These surveys first began in the 1970s and they did improve access to populous population wide data regarding nutrient intakes and plausible deficiencies.
Dr. William Wallace:However, it's really important to note the obvious limitations of survey based data. Most notably, you have recall bias, that's, an individual's ability to recall portion sizes, specific food items, etc. The over a given timeframe. It tends to be rife with error. For instance, there's a study published in 2013 that looked at the validity of calorie intake data collected by NHANES of over 60,000 people spanning four decades in length. What the researchers found was that 59% of men and 67% of women actually under reported total caloric intake. Under reporting was even higher and people considered obese, which is common with dietary recalls. On the other hand, you have children, who tend to over report things like total caloric and nutrient intake.
Dr. William Wallace:Another obvious drawback of survey data is limited precision. What I mean by that is that a 24-hour dietary recalls are usually collected and those are used and as an Approximation of what someone's nutrient intake looks like over a much longer period of time, which is not credit incredibly precise or reflective of day-to-day food choices in the average person. For most people, day-to-day food intake tends to vary quite a bit. As such, it's important to keep in mind, when talking about nutrient deficiencies on a population level, that we cannot draw any conclusions about the causality of diet health relationships. Now, that being said, these surveys are valuable, as they do provide insight into population-wide eating patterns and nutrient intakes. One way in which some of the NHANES studies minimize limitations is by taking a subset of participants and having them undergo biochemical assessments, which is typically through a blood draw or urine, as previously mentioned. You are then now able to take the outcomes of something like an objective biochemical assessment and compare it to the self-reported survey data that's been collected. The way that NHANES tends to work is by collecting self-reported.
Dr. William Wallace:Dietary intake of vitamins and minerals is Estimated by two 24-hour dietary recalls conducted on non consecutive days. The mean of two 24-hour dietary recalls is then used to estimate dietary deficiency and adequacy or excess, based on what is called the estimated average requirement, the recommended dietary allowance and the tolerable upper limit. These are three of the four dietary reference intakes that were set by the National Academy of Medicine Food Nutrition Board. Dietary reference intakes, or DRIs, include the ear, which stands for estimated average requirement. That is defined as the average daily nutrient intake levels estimated to meet the requirements of 50% of healthy individuals in whatever particular group you're looking at. The next dietary reference intake is the RDA, that is, the recommended dietary allowance that I believe most people are familiar with. The RDA is defined as the average daily Nutrient intake levels estimated to meet the requirements of 97 to 98 percent of healthy individuals in a group. It is important to be able to recognize and differentiate between these two things when looking at numbers being reported. The ear is usually used to assess the nutrient intakes of groups because it represents the average requirement for that specific group, that is, 50% of healthy people in that group. On the other hand, the RDA is used to help individuals plan their dietary intake, as its purpose is to cover the needs of all healthy individuals in a group.
Dr. William Wallace:Of course, in future episodes We're going to talk about RDAs for specific nutrients and where those may or may not in fact be enough. The third dietary reference intake is known as adequate intake. You will typically see that abbreviated as AI. This is a recommendation for nutrient intake. When there is not thought to be enough scientific evidence to support the development of an RDA, the adequate intake is set at a level that assumes to help someone meet nutritional adequacy. Examples of nutrients that do not in fact have an established RDA but do have adequate intakes or AI set Those would be choline, vitamin K, potassium, sodium and fiber. Those are the most notable ones. The fourth dietary reference intake is the tolerable upper limit. This is the recommended limit of intake of a specific nutrient unlikely to cause adverse health effects. I will note that these numbers are not always gospel and that sometimes there are nutrients or circumstances where different rules regarding intakes can actually be applied. So a brief recap on the last few minutes or so.
Dr. William Wallace:Micronutrient inadequacies are prevalent in the United States and inadequacy specifically here is defined as nutrient intake above a threshold. That would suggest deficiency, but below recommended intake. And again, the estimated average requirement, or the ear, is what is used as the threshold to determine adequate or inadequate, based on collected data from populations. As I stated earlier, the 2020-2025 Dietary Guidelines for Americans suggest that 90% and 80% of Americans over one year of age are not getting enough fruits and vegetables respectively. Obviously, fruits and vegetables are groups of foods and not individual nutrients, but many important nutrients and micronutrients specifically come from those food groups. In fact, the most recent Dietary Guidelines for Americans went as far as suggesting nutrients of public health concern by age group, due to their underconsumption, as demonstrated by large cohort data like that of NHANES.
Dr. William Wallace:Nutrients of public health concern that are relevant to most people in the United States due to their underconsumption and possible negative impact on health include vitamin D, calcium, potassium and dietary fiber so four big ones. According to the most recent US National Survey data, 95% of all Americans are not getting enough recommended amounts of vitamin D through dietary means, 97% are not meeting requirements of dietary potassium, approximately 50% of people are not meeting calcium needs and 95% of people in the US are not getting enough dietary fiber. Now it's important to note that inadequate intake of vitamin D is so high here because only dietary sources are being considered in these dietary recall studies. The sun exposure is not considered, and only in some cases is dietary supplement intake actually considered As such. You can see how actual deficiency or inadequacy states as shown by blood marker data. It might not match numbers high as 95% of people in the US. So, when you look at specific age groups, nutrients of public health concern due to underconsumption are suggested to be as follows For infants and toddlers, 6 to 11 months of age, vitamin D, potassium, zinc, iron and choline need to be paid extra special attention to.
Dr. William Wallace:For toddlers 1 to 2 years of age, you have vitamin D, calcium and fiber stand out the most, moving on to children and adolescents, 2 to 18 years of age. The big four I listed at the beginning of this take are the most important. That was vitamin D, potassium, calcium and fiber. When looking specifically at females in the 2 to 18 year age range, added to that list would be iron, vitamin B6, vitamin B9, and vitamin B12. Sticking with boys and girls together in the same 2 to 18 years of age range, nutrients that need to be given special consideration but may not reach public health concern status would be magnesium, phosphorus and choline. For women that are pregnant or lactating, vitamin D, calcium, potassium, fiber, iron, vitamin B9, iodine and choline are considered nutrients of public health concern. Lastly, for people over the age of 65, vitamin D, calcium, potassium, fiber, protein and vitamin B12 are listed as being under consumed to the point of being labeled nutrients of public health concern.
Dr. William Wallace:Other nutrients that have not quite been given the label of public health concern nutrients but that still have repeatedly come up as shortfall nutrients in nutrition assessment data in the US include vitamin A, vitamin C, vitamin E, vitamin K, magnesium, zinc and choline. Some of the most recent NHANES data suggests that up to 95% of people in the US are not getting enough dietary vitamin D. I mentioned the limitations of that suggestion just a bit earlier. For vitamin A, the data demonstrates up to 45% of US adults not getting enough. There are 46% of US adults not getting enough vitamin C. Up to 84% are not getting enough vitamin E and up to 70% might not be getting enough vitamin K. An adequate intake of magnesium was demonstrated in over 50% of US adult population and up to 15% of adults were not getting enough zinc. Lastly, over 90% of US adults are not meeting daily choline needs.
Dr. William Wallace:Now, interestingly enough, and unfortunately enough, when this NHANES data is compared to 2013-27 NHANES data, there is an increase in the percentage of people who are not taking in enough vitamin C by 9 more percentage points, a 2% increase in the amount of people not taking in enough vitamin D and 4% more people are not taking in enough vitamin zinc through diet. Interestingly enough, and unfortunately enough, when this NHANES data is compared to 2013-2007 NHANES data, there is an increase in the percentage of people who are not taking in enough vitamin C by 9 more percentage points, a 2% increase in the amount of people not taking in enough vitamin D and 4% more people are not taking in enough zinc through diet. Coupled with a continued increase in the amount of people not getting enough fruits and vegetables, there is a clear negative trend for several important food groups and by proxy key vitamins and minerals. It's important for me to repeat that inadequate intakes demonstrated by this data does not always equate to actual nutrient deficiency. As I stated earlier, nutrient intake data collected via survey usually does not correlate well with biochemical indicators of deficiency. In some cases, when NHANES data is being collected, a subset of participants will be recruited to go to a testing site to undergo biochemical assessment. In other words, blood or plasma markers of some nutrients are looked at to see how well the collected survey data corresponds with deficiency states of certain vitamins and minerals. In fact, the CDC began publishing nutrition reports using blood and urine samples that were collected from participants as part of the NHANES data sets. Remember that NHANES data is collected by the National Center for Health Statistics, which is part of the CDC, so they have access to all that.
Dr. William Wallace:Per the most recent nutrition report published by the CDC and using biochemical NHANES data, of all the nutrients listed in the data set, vitamin B6 actually showed the highest actual clinical deficiency rate, with 10.5% of people being deficient in B6. The next most prevalent clinical deficiency was iron, with 9.5% of people being deficient in iron. One frequently cited study that was published in 2010 and using NHANES data from the same time frame concluded that 42% of people in the US were clinically deficient in vitamin D as indicated by serum levels under 20 nanograms per ml. The CDC nutrition report only reported around 8% of people in the US were deficient in vitamin D, and this is likely because they were using the cutoff value of 12 nanograms per ml proposed by the National Academy of Medicine for clinical vitamin D deficiency. Had the CDC used the endocrine society recommendations, then the percentage of people with an actual vitamin D deficiency would probably be significantly higher. I prefer to follow the endocrine society's recommendations for serum vitamin D levels, and I'll explain why more thoroughly in an episode dedicated to vitamin D. By itself, that should be one of the first episodes looking at a specific nutrient, if I were to guess.
Dr. William Wallace:A study by Bird et al published in 2017 analyzed NHANES data from one of the more recent survey cycles, and their output suggested that 31% of the United States population was at risk for at least one vitamin deficiency or anemia. That is one third of the US population, and that's not a small number. Of all subgroups that were looked at, african Americans had the highest risk, with 55% being at risk of at least one vitamin deficiency. Pregnant and breastfeeding women were close to behind, with women ages 19 to 50 close behind that. The same study went as far as looking at deficiency risks in people who were not using dietary supplements, those that were using dietary supplements and those that were using dietary supplements, but more specifically multivitamin supplements. In this case, a multivitamin was defined as a dietary supplement containing more than at least 12 vitamins and between 7 and 16 minerals. The results suggested that non-dietary supplement users had a 40% risk of having at least one deficiency, dietary supplement users were at a 28% risk and multivitamin users were at a 14% risk of having at least one nutrient deficiency. So less than half the risk of people not using any kind of supplement and half the risk of people using a supplement but not a multivitamin supplement.
Dr. William Wallace:Several other studies also suggest that the use of multivitamin reduces one's risk of vitamin or mineral deficiency. Specifically, a recent study using Enhanes data from 2009 to 2012 found that people using a multivitamin multimineral supplement that contained at least 100% of the RDA, or the adequate intake for at least nine nutrients, had nearly eliminated risk of nutrient deficiency for 15 different nutrients and significantly lowered their risk compared to people not using a multivitamin multimineral supplement in those same nutrients. Magnesium, vitamin D and iron are three nutrients that typically still appear as nutrients people are at risk of deficiency in because they are typically found in lower amounts in multivitamins, as is the case for magnesium and vitamin D, or their absent altogether, as is the case for iron, unless the supplement is specifically geared towards pregnant women or sometimes children. It's noteworthy that in the last two studies I referenced, short term use of multivitamin did not seem to have a meaningful impact on reducing the risk of nutrient inadequacies. The Bloomberg study, that's the more recent one that I referenced, has shown those with the highest compliance of multivitamin use, as defined by multivitamin use more than 21 days per month, had the most impact on eliminating nutrient inadequacies per blood biomarker data. The former study I referenced, covering most of the inadequacy numbers that I referenced, that found small but non-significant decrease in inadequacy risk if someone was using a multivitamin for less than two months, but they didn't look any farther than that. I do need to note that both of those studies had industry funding and it's important to be mindful of potential bias and conclusions.
Dr. William Wallace:However, it is generally accepted that a multivitamin multimineral supplement providing at least 100% of the RDA for as many nutrients as possible, can be an excellent tool for filling nutrient gaps in one's diet. That being said, it's important to keep in mind that the use of things like that in the general population can also pose the risk sometimes of making somebody more complacent in other areas of their diet, using a multivitamin as maybe a crutch instead of how it's intended, that is, as an adjunct to a whole food diet. Although vitamins can be a cost effective and practical tool for ensuring nutrient adequacy, it's important to remind ourselves that supplements I mean they're just that it's something used to supplement the diet and not intended to act as a substitution for nutrients from whole food sources. It is possible to reach adequate nutrient status for most vitamins and minerals from food alone, despite what you hear from your favorite health advocates, but multivitamin supplements can provide a means of practical support for most people regardless. I do have to reiterate that there are very apparent limitations to the use of food frequency questionnaires as well as 24 hour dietary recalls, both of which are used to collect the NHANES data that I just referenced. In addition to that, dietary recall data usually does not correlate well with biochemical indicators of deficiency. However, cross sectional data like that of NHANES can give us a rough idea of what nutrients need more focus on in the American diet.
Dr. William Wallace:31% of Americans may have at least one vitamin deficiency or anemia. The percentage of Americans who have inadequate nutrient status would be higher than that. Remember that inadequacy would be the state prior to a deficiency and likely put someone in what we call marginal deficiency, which we talked about a bit earlier in this broadcast. Micro nutrient inadequacies should be addressed as soon as they're recognized. Although this sounds obvious when said aloud, it's not always easy to identify nutrient inadequacies, as any symptoms someone may have usually present again with non-specific symptoms, including general fatigue, inability to concentrate, irritability, reduced mood, reduced ability to fight infections and so on, although not immediately alarming, if left unchecked marginal deficiencies they can progress into full-blown deficiencies, which does have important implications for long-term health, and both of those things can increase one's risk for chronic disease.
Dr. William Wallace:It was not the objective of this episode to cover individual nutrients and methods of determining or reaching nutrient status of individual nutrients, but this episode hopefully laid the foundation for everyone listening to have a better understanding of nutrients, nutrient definitions, definitions of key terms and so on, as we move forward into future episodes covering the ins and outs of specific nutrients.
Dr. William Wallace:Those episodes will cover ways to determine nutrient status, if available, as well as best practices in reaching nutrient adequacy status. We'll also cover recommended it takes and talk about circumstances under which different recommendations might apply. So, to end, micronutrient deficiencies around the world differ by food availability, cultural preferences and so on, excluding provisional causes, that is, the availability of nutrients. People become nutritionally depleted when stressed or sick. As such, don't wait to take inessential nutrients when stressed or sick or deficient. Provide them, because they are always needed. If you want to learn more about specific nutrients and protocols for identifying nutrient status, attaining or sustaining nutrient status, then please subscribe to the show wherever it is you're listening. If you are not listening on YouTube? please go and subscribe there so that I can continue to build this show up and improve it as I go. Thank you for listening and I do hope to see you again here in the near future.