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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.