Several nutrient shortfalls have been noted within the US population.7,8 Analysis of National Health and Nutrition Examination Surveys (NHANES) suggests that micronutrient malnutrition is common in the United States with an estimated 31% of the population at risk of developing one or more micronutrient deficiencies.8
The “Hidden Hunger”
The term “hidden hunger” is used to describe vitamin and mineral deficiency. When someone’s habitual diet consists of foods that lack necessary levels of micronutrients, the resulting health impacts may not always be acutely visible.5 Micronutrient malnutrition has been associated with a wide range of physiological impairments, including metabolic disorders; reduced immune, endocrine and cognitive function; and delayed or inadequate physical development.2,4,8
Some micronutrient deficiencies may also be an underlying cause of chronic disease. Magnesium, for example, is present in a variety of foods from greens to whole grains, yet it is under-consumed in the US.7,9,10 Studies indicate that low magnesium intake has been associated with a greater risk for several chronic diseases, including cardiovascular disease (CVD), type 2 diabetes, metabolic syndrome, depression, and decreased cognition.9,11
Combined US reports indicate that micronutrients, such as magnesium, calcium, potassium, iron, and vitamins A, D, and C, are under-consumed by children and adults in the US relative to dietary guidelines for life stages and the estimated average requirements (EAR).7-9,12 The overall high-calorie, low-nutrient quality of the commonly consumed Western-type diet, comprised of more processed foods and less vegetables, is one important component of this nutritional issue.12 Further, analyses of surveys suggest that certain sub-populations in the US are more vulnerable to micronutrient deficiencies or may have an increased micronutrient need, such as the following:8,13
- Individuals with low-nutrient diets or on restrictive diets
- People of low socio-economic status or those experiencing food insecurity
- Women, particularly those of child-bearing age
- Older adults
- Individuals with certain medical conditions or disease states
In addition, long-term users of medications may also experience interference with their body’s ability to absorb and benefit from the nutrients found in foods.14 Potential drug-nutrient depletions have been noted for commonly prescribed pharmaceuticals with micronutrients such as magnesium, calcium, B vitamins, including B12 and folate, potassium, and zinc most often mentioned as potentially impacted.15
Phytonutrients are plant-based chemicals available through a diet that includes whole grains, beans, fruits, vegetables, spices, and herbs. Research suggests that these bioactive compounds, which contribute to a plant’s color, taste, and smell, also have beneficial health effects. For example, flavonoids are compounds found in cocoa, apples, and tea. Epidemiological studies have suggested a positive association between diets high in flavonoid-rich foods and cardiovascular health while clinical trials have shown lower blood pressure results after consumption of flavonoid-rich food.16 In addition, phytochemicals such as sulforaphane and lycopene have health-promoting properties and protective effects against many diseases, including cancers.17,18 Even with the suggested benefits, according to a Centers for Disease Control and Prevention report, only one in ten adults meet the recommendations for fruit and vegetable daily intake, potentially increasing their risk for developing chronic diseases such as type 2 diabetes and heart disease.19
Assessment and Treatment Strategies
Evaluating nutrient deficiencies is vital piece of my clinical intake assessments to determine underlying causes of chronic symptoms or conditions. Due to the essential nature of micronutrients at the cellular level, addressing one or multiple deficiencies has the potential to resolve many health issues either in part or completely. Personalized nutrition strategies may include supplementation, new dietary habits, or structured food plans. The functional medicine model that I use in my office uses a framework that prioritizes a comprehensive view of a patient’s historical and current conditions, including nutrition intake and dietary patterns, to determine appropriate interventions for each individual patient. The functional medicine approach also emphasizes a doctor-patient collaboration to fully involve you in your treatment plan and to provide support during your journey to wellness.
- Vitamin and mineral nutrition information system (VMNIS): micronutrient database. World Health Organization. https://www.who.int/vmnis/database/en. Accessed February 21, 2020.
- Allen L, de Benoist B, Dary O, Hurrell R, eds. Guidelines on food fortification with micronutrients. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/43412/9241594012_eng.pdf. Published 2006. Accessed February 20, 2020.
- Thompson B, Amoroso L, eds. Combating Micronutrient Deficiencies: Food-Based Approaches. Rome, Italy: CAB International and Food and Agricultural Organization of the United Nations (FAO); 2011.
- Baily RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66(suppl 2):22-33. doi: 10.1159/000371618.
- Ritchie H, Roser M. Micronutrient deficiency. Our World in Data. https://ourworldindata.org/micronutrient-deficiency. Published August 2017. Accessed February 20, 2020.
- Nutrition: micronutrient Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/micronutrient-malnutrition/micronutrients/index.html. Published August 12, 2019. Accessed February 20, 2020.
- US Department of Health and Human Services and US Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th ed. Available at http://health.gov/dietaryguidelines/2015/guidelines; 2015.
- 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)pii:E655. doi:10.3390/nu9070655.
- Drake VJ. Micronutrient inadequacies in the US population: an overview. Linus Pauling Institute, Oregon State University. https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview. Published March 2018. Accessed February 20, 2020.
- What we eat in America, NHANES 2011–2012. US Department of Agriculture, Agricultural Research Service. https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/1112/Table_37_SUP_GEN_11.pdf. Published 2014. Accessed February 21, 2020.
- Rosanoff A, Dai Q, Shapses SA. Essential nutrient interactions: does low or suboptimal magnesium status interact with vitamin D and/or calcium status? Adv Nutr. 2016;7(1):25-43. doi:10.3945/an.115.008631.
- Marriott BP, Olsho L, Hadden L, Connor P. Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003-2006. Crit Rev Food Sci Nutr. 2010;50(3):228-258. doi:10.1080/10408391003626223.
- Drake VJ. Subpopulations at risk for micronutrient inadequacy or deficiency. Linus Pauling Institute, Oregon State University. https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/subpopulations-at-risk. Published March 2018. Accessed February 20, 2020.
- Are your medications causing nutrient deficiency? Harvard Health Publishing, Harvard Medical School. https://www.health.harvard.edu/staying-healthy/are-your-medications-causing-nutrient-deficiency. Published August 2016. Accessed February 13, 2020.
- Pharmavite LLC. Common drug classes, drug-nutrient depletions, and drug-nutrient interactions. https://www.aafp.org/dam/AAFP/documents/about_us/sponsored_resources/Nature%20Made%20Handout.pdf. Published 2017. Accessed February 13, 2020.
- Rees A, Dodd GF, Spencer JPE. The effects of flavonoids on cardiovascular health: a review of human intervention trials and implications for cerebrovascular function. Nutrients. 2018;10(12):1852. doi:10.3390/nu10121852.
- Klomparens EA, Yuchuan D. The neuroprotective mechanisms and effects of sulforaphane. Brain Circ. 2019;5(2):74-83. doi:10.4103/bc.bc_7_19.
- Grabowska M, Wawrzyniak D, Rolle K, et al. Let food be your medicine: nutraceutical properties of lycopene. Food Funct. 2019;10(6):3090-3102. doi:10.1039/c9fo00580c.
- Men, younger adults, and people living in poverty get fewest fruits/vegetables. Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2017/p1116-fruit-vegetable-consumption.html. Published November 16, 2017. Accessed February 21, 2020.