Nutritional deficiencies usually occur secondary to a primary condition (e.g., irritable bowel disease, cancer, pregnancy), and progress over time from a state of nutritional inadequacy to a state of serious illness or even death. The development of a nutrient deficiency usually goes through the following stages:

• Adequacy
• Negative balance
• Decline in tissue stores
• Loss of function
  • Signs and symptoms of deficiency
  • Organ failure
• Possible death

So, how do we get to a state of negative balance?

The cause of any nutritional deficiency can be boiled down to one (or more) of five causes:

• Inadequate intake
• Poor absorption
• Increased requirement
• Altered metabolism
• Losses greater than gains

There are a variety of reasons for each of the above causes. For example, an underlying gluten-sensitive disease of the intestines would contribute to a nutrient deficient state due to poor absorption. Other reasons of a nutrient deficient state include:

• Inadequate intake – poor food choices, not consuming enough food, feeding or swallowing difficulties
• Poor absorption – inflammatory bowel disease, excess alcohol intake, Celiac disease
• Increased requirement – growth, pregnancy and lactation, recovery states
• Altered metabolism – excess alcohol intake, environmental pollution, genetic variations, disease processes, drugs
• Increased losses – renal disease, poorly controlled diabetes, burns, chronic diarrhea

As you can see, a nutrient deficient state can develop for reasons other than just poor intake.

It is worth mentioning that mild nutrient deficiencies are much more prevalent than severe ones. This means that patients often feel something is wrong before a physician is able to observe signs of nutrient deficiency. Naturopathic physicians rely on lab values, but also the patients experience (or symptoms) in order to create a viable treatment plan; therefore, mild deficiencies can be treated before they turn into severe ones.

Current research is now moving toward the diagnosis and treatment of marginal nutrient deficiencies of single or multiple nutrients. This is important because nutrient deficiencies are quite prevalent and play a role in many disease processes. For example, studies have found severe population deficiencies of vitamin K₁ in the United States leading to a decline in bone health. Other nutrient deficiencies play a roll in depression, diabetes, cancer, etc.  Nutrient deficiencies are the most common cause of a depressed immune system.

In order to correct a potential nutrient deficiency, talk to your naturopathic physician. First off they will want to find out why the deficiency is occurring (*remember: inadequate intake, poor absorption, increased requirement, altered metabolism, increased losses) in order to treat the underlying cause of the deficiency. This will likely include a series of lab tests, but also an in-depth look at the patients’ symptoms. Treatment may include supplementation, dietary counselling, acupuncture, botanical medicine, etc. Treatment plans are often tailored to each individual’s needs and reasons for nutritional deficiencies. The best way to avoid a nutrient deficiency is to make sure you are eating a balanced, nutrient-rich diet.

Over the course of everyday life, your body is interacting with many different factors which have been developed to kill bacteria or have that effect when we are exposed to them.​ Here are a few of them:

1. Excessive sugars are food for unhealthy bacteria in and on our bodies.
2. Food Additives. (Link to allowed food additives.)
3. Pesticides (like RoundUp) which have been sprayed on agricultural products.
4. Antibacterial soaps and cleaners.
5. Antibiotics either given to you or used on your foods (meat, chicken and eggs, farmed fish, etc)
6. Chemicals, known (chlorine and fluoride) or unknown (food additives – colours, preservatives, etc)
7. Environmental pollutants

Because it is virtually impossible to avoid this entire list, it is likewise necessary to actively manage your body’s microflora. How is this done?

1. Actively avoid the items on the list above.
2. Choose fermented foods to include in your daily diet (more about this below).Spend time in nature where your body will get exposure to a broad spectrum of bacterial strains.
3. Having a regular contact with animals is also beneficial.
4. Boost your soluble and insoluble fibre intake, examples being cooked, then refrigerated potatoes and unripe tropical fruits banana and plantains
5. Probiotics taken intermittently.

​Daily exposure to broad spectrum bacterial sources are important, ​more important than supplementation.  When you are consuming fermented foods (kim-chi, miso, sauerkraut, kombucha, kefir, yogurt etc) you are ingesting many strains of bacteria that exist in these cultures. The greater number of beneficial strains that you have in your body the more resilient you will be to the harmful effects of the detrimental insults previously mentioned.  Even with this daily re-inoculation, most people do better when they supplement at regular intervals.  Most people who supplement with probiotics do not realize that they can achieve the necessary effect without continuously consuming probiotics.  My recommendation is take a course 14 days at 100 billion or 30 days at 30-50 billion every 3-4 months.  I prefer multi-strain products unless there is a specific goal that you are trying to target.

Be wary of the vast assortment of products that now claim to have probiotic capacity.  Many of these grocery store items only have token amounts of the claimed bacterial in them and many of them have strains that are not necessarily shown to provide a  benefit.  There is a CBC radio show that recently highlighted the “probiotic industry.”  It was well done and worth taking the time to listen to: GUTSY – The Fridge Light.  After all this you will likely know more than you want to about probiotics.

I have been spending time reviewing individual nutrients recently.  Sometimes relearning feels far more important than the first time I learned; it feels familiar and the importance of the details can really be driven home.  Let me explain myself.

Today, I am reviewing about niacinamide.  This is a well know B vitamin.  Now we all need it, but if you are a person who is dealing with osteoarthritis (OA), metabolic syndrome or diabetes then this is of higher relevance to you.

In medicine, we seem to have a fondness for new evidence; but sometimes we seem to forget what we once knew and this is the case here.  Dr William Kaufman published a book in 1949, (almost 70 years ago) where he painstaking detailed how he relieved OA pain in many of his patients (about 90% of them).  He did not understand at the time how this was working, just that it was working and the world should know about it.

Now in more recent times, we are making a connection between OA and imbalanced blood sugar levels in conditions like diabetes and metabolic syndrome. Up to 80% of people with OA have been shown to have challenges controlling blood sugar. This is where we seem to see the link.

Niacinamide is a factor that supports the energy production in cells.  When the cells have enough niacinamide they function at a higher level.  One cell type that specifically benefits is the stem cells that are precursors to pancreatic eyelet cells where insulin is produced.  Just to close the loop for you, insulin is the signal that reduces blood sugar.

This one nutrient taken at around 3 g through the day after 3-4 weeks can improve or resolve OA pain and help control diabetes as long as you continue to take the vitamin. We knew this all along and nobody told you until now.

Kaufman W. The Common Form of Joint Dysfunction: Its Incidence and Treatment.Brattleboro, VT: EL Hildreth and Company, 1949.

Qi Zhuo et al. Metabolic syndrome meets osteoarthritis Nature Reviews Rheumatology 8, 729-737, 2012.

Of all the vitamins, the greatest amount of discussion tends to be around Vitamin D. It is hotly debated because the research is unclear; experts strongly disagree with one another on adequate/dangerous levels in the blood and on dosing to achieve those blood levels.

What is Vitamin D?
Vitamin D is different from other vitamins, because it can actually be made by the body. Once it is made, the body then uses it more like a hormone than as a metabolic support molecule (like other vitamins). It also differs because it is not acquired from food, rather it is created by inactive Vitamin D being exposed to effective sunlight. The reaction takes place on the skin and the activated Vitamin D is then reabsorbed and circulated throughout the body.
Vitamin D is commonly known to support bone health as an overt shortage leads to rickets (ineffective mineralization of the bones). But it is needed for healthy cardiovascular function, immune health, brain and nervous system function, cancer prevention, muscle health, etc. Recently there has been evidence showing that Vitamin D is protective against Alzheimers, depression, hypertension, and autoimmune diseases like Crohns, rheumatoid arthritis, type 1 diabetes and multiple sclerosis.
Specifically Vitamin D regulates calcium in the blood bones and digestive tract, as well as insuring proper intercellular communication.

Where Does Vitamin D Come From?
As mentioned above there is very little Vitamin D in food so it must be obtained from the sun or via supplementation. The sun is not so much the source of the Vitamin D as it is a key component in the production of the vitamin. Human skin is capable of creating large amount of Vitamin D when exposed to ultraviolet B radiation (UVB) from the sun. However, it is now considered a healthy practice to protect yourself from all UVB light using sunscreens resulting in large numbers of people being significantly low in Vitamin D. Factors that affect Vitamin D production:
1. Your complexion: A fair-skinned person can get up to 25000IU in a 15 min exposure. You don’t need to tan or burn your skin in order get Vitamin D. Darker skinned individuals take substantially longer to achieve similar levels.
2. Where you live and the time of year: The farther north you live, the smaller your annual window for getting adequate UVB from the sun. In southern BC, you get insufficient UVB from the end of August until April to have any effect on your Vitamin D levels.
3. The amount of bare skin exposed: The more skin exposed the greater the effectiveness of the exposure.
Vitamin D supplements are really your only other choice. This is a major issue for health within our society.

Healthy Dosing Levels
There are many different groups that have different recommendations of daily levels of supplementation.
1. Food and Nutrition Board: Adults 600-800 IU – forms the basis for recommendations of both the Canadian and American governments; however they tend to be significantly behind on updating their numbers
2. Endocrine Society: Adults 1500-2000 IU – recognized society of doctors of endocrinology
3. Vitamin D Council: Adults 5000 IU – an advocacy group dedicated to Vitamin D awareness and health promotion

So who do you rely on? It seems that when the specialist cannot agree you have to come to your own decisions. I tend to feel that 4000 IU for 3 months followed by testing of blood levels is a good compromise given that most people are low. Other doctors test first and treat accordingly but I find everyone tests low on initial baseline testing. Blood levels should be greater than 30 ng/ml, but optimal levels are 70-80 ng/ml.

Other interesting insights:
There was some research comparing the Vitamin D levels of two groups: surfers in Hawaii and hunter gatherers in Africa. All logic should lead to the simple conclusion that the African group would have lower Vitamin D levels due to their darker complexion. It turned out that the Hawaiians had 30 ng/ml and the Africans had 50 ng/ml. Why? One argument was the surfers were protected with sunscreen, but that turned out to be false as they denied ever applying it. There is the possibility genetics were affecting the numbers. But there is a greater possibility Vitamin D was being washed off the surfers before they had the chance to reabsorb it. Eighty year old research actually supports this line of thinking. Given that reality, the effects of modern hygiene may be inadvertently negatively affecting the majority of us. We, as a rule, wash ourselves often; cleaning off both the filth and, apparently, some positive chemicals, like Vitamin D, from our skin.

Given the number of conditions with an association to low Vitamin D, our northern location, and culture of washing. For this vitamin, there is plenty of argument for supplementing or testing.