Key Takeaways (expand)
- Nearly one third of Americans are at risk for a disease of malnutrition arising from at least one vitamin deficiency or anemia.
- Some demographic groups are at higher risk for a disease of malnutrition, showing racial disparities, sex disparities and socioeconomic disparities.
- Almost all Americans have dietary insufficiencies of essential vitamins and minerals, which increases risk for chronic and infectious disease.
- The high prevalence of nutrient insufficiencies and deficiencies are the direct result of low dietary intake. That’s why Nutrivore is so important!
The goal of a Nutrivore approach is to get all of the nutrients our bodies need from the foods we eat. If this sounds like an incredibly basic concept, well, I admit, it is! And yet, Nutrivore represents a completely new way to think about foods. As evidence of the failure of dietary advice to date to teach us how to choose foods such that we do meet all of our nutritional requirements, whether from your favorite diet guru or government dietary guidelines: almost all of us are nutrient deficient or insufficient. This increases risk of both chronic and infectious disease, eroding both our health and quality of life.
Let’s look at the statistics.
Nutrient Deficiencies Are Surprisingly Common
Nutritional deficiency is defined inadequate dietary intake of an essential nutrient resulting in a disease of malnutrition, such as iron-deficiency anemia (iron), scurvy (vitamin C), rickets (vitamin D), beriberi (vitamin B1), pellagra (vitamin B3), and night blindness (vitamin A).
A 2017 study estimated the prevalence of deficiency in vitamin A, vitamin B6 (pyridoxine), vitamin B9 (folate), vitamin B12 (cobalamin), vitamin C, vitamin D, and vitamin E, as well as anemia, based on biochemical markers using data from blood tests taken as part of the 2003 to 2006 National Health and Nutrition Examination Survey (NHANES). The study showed that 31% of Americans are at risk for at least one vitamin deficiency or anemia, with 6.3% of the U.S. population at risk for two vitamin deficiencies or anemia and 1.7% of the U. S. population at risk for 3 to 5 vitamin deficiencies or anemia.
The study further identified demographic disparities with several groups at higher risk, including:
- 37% of women are at risk for at least one vitamin deficiency or anemia
- 55% of non-Hispanic Blacks are at risk for at least one vitamin deficiency or anemia
- 40% of individuals from low income households are at risk for at least one vitamin deficiency or anemia
- 42% of individuals without a high school diploma are at risk for at least one vitamin deficiency or anemia
- 42% of underweight individuals are at risk for at least one vitamin deficiency or anemia
- 39% of obese individuals are at risk for at least one vitamin deficiency or anemia
Demographic disparities (including racial disparities, sex disparities, and socioeconomic disparities) have been found in many other studies. For example, the CDC’s Second Nutrition Report found that menstruating women are more likely to be iron deficient, non-Hispanic Blacks are more likely to be deficient in vitamin D, and women ages 20 to 39 are more likely to be iodine deficient.
The study authors further identified low dietary intake as the reason for the high prevalence of nutrient deficiencies. Their analysis showed that only 6.4% of the study population consumed at least the Estimated Average Requirement (EAR) for each of the vitamins A, B6, B9, B12, C, E, and iron.
Nearly one third of Americans are at risk for a disease of malnutrition arising from at least one vitamin deficiency or anemia.
Symptoms of vitamin A deficiency include impaired immune function resulting in frequent infections, stunted growth, dry skin and eyes, and night blindness.
Symptoms of vitamin C deficiency include fatigue, depression, and connective tissue defects resulting in gingivitis, petechiae (pinpoint spots caused by bleeding under the skin that can look like a rash), rashes, internal bleeding, and/or impaired wound healing.
Symptoms of vitamin D deficiency include fatigue; depression, anxiety, and irritability; muscle weakness, aches or cramps; join pain; osteomalacia (softening of the bones) and osteoporosis; and rickets (characterized by delayed growth, bow legs, weakness, and pain in the spine, pelvis, and legs). Vitamin D deficiency also increases risk of infection, cardiovascular disease, type 2 diabetes, obesity, cancer, autoimmune disease, and neurodegenerative disease.
The symptoms of anemia include fatigue, weakness, pale skin, shortness of breath, lightheadedness, dizziness, and rapid or irregular heartbeat. Anemia can be caused by iron deficiency, but additionally deficiencies in B vitamins can cause different types of anemia: vitamin B9 (folate) deficiency causes megaloblastic anemia, vitamin B6 (pyridoxine) deficiency causes microcytic anemia, and vitamin B12 (cobalamin) deficiency causes pernicious anemia.
It’s important to note that often the early symptoms of nutrient deficiency are non-specific, and can include vague symptoms like fatigue, irritability, aches and pains, and increased frequency of infections like colds and flu.
Nutrient deficiency isn’t the only concern, however. Nutrient insufficiency also contributes to health challenges.
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Nearly Everyone Is Nutrient Insufficient
Nutrient insufficiency (or shortfall, or inadequacy) is defined as usual dietary intake falling below the Estimated Average Requirement (EAR) but without clear disease of deficiency. It’s the amorphous gray in between intake being so low as to cause a nutrient deficiency and actually meeting the bodies nutritional needs of that nutrient by consuming enough to hit the Recommended Dietary Intake on a regular basis. In this case, the biggest concern is that nutrient insufficiencies are increasingly showing up as a major underlying driver of chronic disease, increasing risk for cardiovascular disease, type 2 diabetes, obesity, cancer, chronic kidney disease, asthma, allergies, neurodegenerative disease, and infection.
The Link Between Nutrients and Disease Risk
What does the high prevalence of micronutrient deficiencies mean for human health? The news isn’t good! While diseases of deficiency like scurvy and pellagra are rare in Western countries, more complex collections of nutrient insufficiencies and deficiencies are linked to increased risk for chronic diseases.
Our food system is abundant in calories (the U.S. produces about 6,000 calories’ worth of food per person per day), but the Standard American Diet is deficient in most of the essential vitamins and minerals that our bodies need to be healthy. In fact, multiple analyses of food intakes have shown that most Americans routinely consume inadequate amounts of essential vitamins and minerals.
A 2011 study evaluated American’s usual nutrient intake including nutrients that are naturally-occurring in foods, from fortified and enriched foods, and from supplements. The results are astounding. The table below shows the proportion of American adults whose usual diet falls short of the EAR for most of the essential vitamins and minerals.
Prevalence of Nutrient Insufficiencies
| Nutrient | Proportion of Americans adults consuming less that the EAR |
|---|---|
| Vitamin D | 100% |
| Potassium | 97.8% * |
| Vitamin E | 96.2% |
| Vitamin B9 (Folate) | 90.2% |
| Vitamin A | 80.1% |
| Vitamin K | 72.4% * |
| Magnesium | 66.3% |
| Vitamin B1 (Thiamin) | 56.3% |
| Calcium | 54.9% |
| Vitamin C | 52.0% |
| Vitamin B6 (Pyridoxine) | 25.5% |
| Iron | 23.1% |
| Zinc | 16.8% |
| Vitamin B3 (Niacin) | 11.7% |
| Vitamin B2 (Riboflavin) | 9.6% |
| Vitamin B12 (Cobalamin) | 7.2% |
| Copper | 5.4% |
| Phosphorus | 2.0% |
| Selenium | 1.1% |
*Vitamin K and potassium do not have EARs established. For these two nutrients, the number in the table above is the percentage of people who are not consuming the Adequate Intake level.
While the proportion of American adults consuming the EAR of essential vitamins and minerals is improved once you account for intake from dietary supplements (like a multivitamin) and fortified and enriched foods, one quarter or more of American adults are still consuming inadequate amounts of:
- potassium (97.3% of Americans don’t get enough; based on Adequate Intake)
- vitamin D (68.3% of Americans don’t get enough)
- vitamin K (66.1% of Americans don’t get enough; based on Adequate Intake)
- vitamin E (58.4% of Americans don’t get enough)
- magnesium (48.3% of Americans don’t get enough)
- vitamin A (37.3% of Americans don’t get enough)
- calcium (35.7% of Americans don’t get enough)
- vitamin C (28.3% of Americans don’t get enough)
Additionally, a large collection of studies show that getting nutrients from dietary supplements doesn’t improve health outcomes compared to getting nutrients from foods, so this higher level of dietary intake when accounting for dietary supplements isn’t necessarily meaningful from a health perspective (although it may be for certain conditions).
Why Ditch the Multivitamin
Why not simply reach for a multivitamin to supply the essential nutrients lacking in most diets? The concept of a multivitamin as nutritional insurance has been busted by the scientific literature. In fact, meta-analyses demonstrate that taking a daily multivitamin has absolutely no effect on all-cause mortality, a general marker of health and longevity, nor cardiovascular disease incidence and mortality, nor cancer prevention.
We should also keep in mind that all of the above percentages are averages. As is the case with nutrient deficiencies, when we group people based on age, race/ethnicity, sex, and various lifestyle factors, certain groups have higher nutrient insufficiency rates than others. In addition, dietary insufficiency of essential nutrients are more prevalent among people living with food insecurity. A 2020 study found that adults living with food insecurity had a higher risk of micronutrient insufficiency for most of the vitamins and minerals examined when compared with food secure adults, the only exceptions being for calcium, iron (examined only in men), vitamin B9 (folate), and choline.
Nearly all Americans routinely consume inadequate amounts of essential vitamins and minerals, even when you take supplements and fortified foods into account.
This also doesn’t take into account how, for example, different diet and lifestyle factors can increase our nutrient needs and render our intakes insufficient even when we appear to be meeting the Recommended Daily Allowances. For instance, a high intake of added sugars can increase the body’s requirements for calcium, vitamin C, magnesium, chromium, and vitamin D. Chronic stress can deplete our levels of vitamin C, magnesium, calcium, iron, zinc and vitamin B3. And, smoking increases the body’s requirements for vitamin C.
Yes, nearly everyone is nutrient insufficient.
The Causes of Nutrient Deficiencies
The high prevalence of nutrient insufficiencies and deficiencies are the direct result of low dietary intake, and are contributing to diseases of malnutrition and chronic illness. Why is our dietary intake of essential nutrients so low?
The Causes of Nutrient Deficiencies
Why do almost all of our diets fall short of meeting our body’s nutritional needs? The complex reasons include: ultra-processed and hyperpalatable foods displacing more nutritionally valuable options; dietary guidelines historically focusing on nutritionally underwhelming foods; and, weight-loss and fad diets propelling diet myths, healthism, and restrictive eating patterns. Basically, it’s harder than ever to choose healthy foods, and most people are confused about which foods those even are.
Despite the long-established Recommended Daily Intake of essential nutrients and increasing awareness of the importance of non-essential nutrients (like CoQ10 and polyphenols), no mainstream diet nor government dietary guidelines has ever integrated the concept of nutrient sufficiency, meaning we get all of the essential and non-essential nutrients our bodies need to thrive from the foods we eat, nor taught nutrient awareness, meaning a basic understanding of what foods contain what nutrients. That’s what Nutrivore is here to address. You can apply Nutrivore principles to however you eat now to up your nutrient intake from foods.
Take-Home Message
Nutrient deficiencies and insufficiencies are surprisingly common, and they lead to health problems and increase risk of chronic and infectious disease. That’s why the Nutrivore concept is so important: selecting foods in order to meet the body’s nutritional needs
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Citations
Expand to see all scientific references for this article.
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Bailey 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. Epub 2015 Jun 2. PMID: 26045325.
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Devarshi PP, Legette LL, Grant RW, Mitmesser SH. Total estimated usual nutrient intake and nutrient status biomarkers in women of childbearing age and women of menopausal age. Am J Clin Nutr. 2021 Apr 6;113(4):1042-1052. doi: 10.1093/ajcn/nqaa392. PMID: 33567452; PMCID: PMC8023996.
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Higgins KA, Bi X, Davis BJ, Barraj LM, Scrafford CG, Murphy MM. Adequacy of total usual micronutrient intakes among pregnant women in the United States by level of dairy consumption, NHANES 2003-2016. Nutr Health. 2022 Feb 8:2601060211072325. doi: 10.1177/02601060211072325. Epub ahead of print. PMID: 35132897.
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