Deficiency, even in food abundance
Even when food is plentiful and easily available, there are some minerals and trace elements that are considered “shortfall nutrients.” With some of these minerals, such as calcium, it often takes years before a deficiency becomes noticeable. With others, such as iron or magnesium, a deficiency can be recognized relatively quickly by specific symptoms. It’s important to correctly interpret these signs so you can then consult a doctor to help you determine whether you have a deficiency and take action if needed.
We’ve put together an overview of the five most common mineral deficiencies in America, their symptoms, and an explanation of who’s at high risk.
1. CALCIUM – To be observed for life
Calcium deficiency affects almost everyone, regardless of age, sex, or dietary habits. Even if sufficient calcium is available in the diet, a common Vitamin D deficiency means that the mineral cannot be sufficiently absorbed and is, therefore, not sufficiently stored in the bones.
A study of 16,444 participants showed that 44% of Americans don’t meet the recommended daily intake of calcium. This means that almost one out of every two of us needs to urgently take action. Calcium is very important for many different functions—it’s a building block for bone and tooth tissues. Together with magnesium, it also plays an important role in muscle contraction and the transmission of stimuli in the nervous system.
It is difficult to measure calcium deficiency using blood tests because of the huge reserve of calcium stored in the bones. On average, men’s bones contain 1 kg of pure calcium; women’s bones contain around 0.8 kg. If the calcium concentration in the blood drops, the parathormone regulates the supply from the bone stores. If the calcium levels are within the normal range, this primarily means that the hormones are working properly, but those levels don’t provide information about actual supply status. This means that normal calcium blood values may be accompanied by reduced bone density—and this is long before any effects on the skeleton or teeth occur.
"Calcium deficiency affects almost everyone, regardless of age, sex, or nutritional habits"
Signs and symptoms of inadequate intake
Reduced bone density (determined by x-ray measurement/DXA), wobbly teeth due to weakness of the jaw bone, neuromuscular hyperexcitability (tetany) with numbness, pins and needles sensation (paranesthesia), cramping (especially of the hands or feet), cardiac arrhythmia, and/or an increased tendency toward allergies.
Risk groups
- People with Vitamin D deficiency: Calcium is actively absorbed in the body from food with the help of Vitamin D. In the absence of the vitamin, calcium can passively diffuse through the intestinal wall, but the amount absorbed this way is usually insufficient to meet daily requirements.
- Lactose intolerant people and vegans: Milk and dairy products provide easily absorbable calcium. Anyone who has to do without this food group due to an intolerance to lactose or a milk protein allergy should keep an eye on their calcium intake. The same applies if animal products are generally not a part of your regular diet.
- Young people who are underweight: Up to the age of 30, the body can store large amounts of calcium in the bones. Studies show that a low body mass index (BMI <18.5) is associated with lower bone density. This is attributed, among other things, to the low calcium supply of an overall reduced intake of food.
What should I do if I have a calcium deficiency?
First and foremost, it’s important to consume foods rich in calcium. Some vegetables, such as kale, chard, fennel, and spinach, score high points for calcium (however, the dietary fibers or phytic acids can inhibit absorption). In addition, some mineral waters contain significant amounts of calcium.
If no dairy products are consumed, calcium supplements are useful. Be sure to look at the list of ingredients before selecting a supplement product. Compounds such as calcium citrate or calcium gluconate are better absorbed and cheaper than the more commonly used calcium carbonate. Algae or corals are also considered to be readily bioavailable sources of calcium. If bone density is already low (osteoporosis or, the precursor, osteopenia), special preparations with protein-bound calcium and other components of the bone matrix (phosphorus, magnesium, silicon) are necessary. It’s also important to remember to combine this mineral with Vitamin D.
2. MAGNESIUM – The sport and stress mineral
National dietary surveys show low intake of magnesium in the U.S. More than one-half of the U.S. population (ages ≥4 years) takes in insufficient levels of magnesium. Despite being widely under consumed, magnesium is not officially considered to be a mineral that we are deficient in, as blood values are usually within the normal range. However, this is probably due to a biochemical peculiarity: 99% of magnesium is found in the cells, not in the blood. This means that even if the laboratory values are within the normal range, there may already be a deficiency in the tissue. Magnesium deficiency is difficult to measure, but it can certainly be felt and recognized.
Signs and symptoms of inadequate intake
Low stress tolerance, sensitivity to noise, muscle cramps and a tendency toward spasms, twitching of the eyelid, constipation, nervousness, restlessness, sleep disorders, increased blood pressure, and/or cardiac arrhythmia.
Risk groups
- People under stress: When a person is under stress, magnesium is released from the tissue into the blood and excreted via the kidneys. This reduces the magnesium level and, at the same time, stress tolerance. More stress means that even more magnesium is lost. This vicious cycle needs to be broken.
- Competitive and endurance athletes: A lot of magnesium is lost through heavy or prolonged sweating (about 35–120 mg/l). This isn’t a problem in the short term, but anyone who regularly sweats a lot should keep an eye on their magnesium level.
- People who use medication to protect the stomach: Proton pump inhibitors reduce the production of stomach acid. This creates an acidic environment by dissolving the magnesium compounds. Only the dissolved magnesium ion (Mg2+) can be absorbed into the body. Too little gastric acid means fewer magnesium ions. If the medicine is used continuously, a massive magnesium deficiency becomes a real threat.
What should I do if I have a magnesium deficiency?
A magnesium-rich diet is essential. The front-runners among magnesium-containing foods are sunflower seeds (with approx. 420 mg/100 g), followed by linseed, wheat bran, sesame seeds, poppy seeds, peanuts, almonds, and oat flakes. In contrast, bananas, which are generally considered a good source of magnesium, contain only about 36 mg/100 g.
Anyone who has signs of a deficiency or is in the risk group should take a magnesium supplement. The combination of several magnesium compounds is preferable to a mono-supplement with only one compound. Each compound has a typical pH range in which it is most soluble. Special supplements contain several magnesium compounds to ensure uniform solubility along the entire digestive tract.
Important: Magnesium should be ingested regularly in low doses. Excessively high doses of magnesium (250 mg or more) are not completely absorbed into the body’s cells and can lead to diarrhea; therefore, it’s important to spread magnesium intake throughout the day (e.g., 2 to 3 x 120–140 mg/day).
3. IRON – Not just a woman’s problem
Iron deficiency is the most common mineral deficiency worldwide, and the U.S. is no exception. Iron deficiency can massively impair the quality of life of those affected. In most cases, high blood loss and a genetic disorder of absorption or low iron in the diet are considered to be the cause of persistent iron deficiency. Iron is not an exclusively female issue. In fact, it is labeled as a “nutrient of public concern” for different subgroups. Children and the elderly are more frequently affected than is generally assumed, and a recent survey showed that 40% of vegans were iron deficient.
Signs and symptoms of inadequate intake
Anemia, paleness; fatigue, exhaustion, low performance; sensitivity to cold; brittle nails; restless legs; increased susceptibility to infection.
Risk groups
- Women of childbearing age: Due to menstrual bleeding, women lose a lot of iron, which must be supplemented above the normal requirement. In addition, more iron is needed during pregnancy and while breastfeeding.
- Competitive athletes: As a central component of hemoglobin, iron is responsible for oxygen transport to the mitochondria. In addition, it has functions in the respiratory chain and is indispensable for energy production. Endurance and competitive athletes have an increased turnover and an increased need for iron.
- People taking certain medications: Iron from food tends to form insoluble complexes. A variety of drugs—such as proton pump inhibitors (for stomach protection), antibiotics, thyroid hormones, and bisphosphonates (for the treatment of osteoporosis)—impair iron absorption. Internal bleeding in the gastrointestinal tract, which can be triggered by acetylsalicylic acid (aspirin) or diclofenac, can also often lead to unnoticed iron loss.
- Other: Individuals in particular growth phases, such as teenagers, and individuals with absorption disorders due to food intolerances tend to need higher levels of iron.
What should I do if I have an iron deficiency?
Iron supplements are the method of choice for treating iron deficiency. However, they are often poorly tolerated, especially if taken in high doses. For example, some supplements contain up to 100 mg of iron per tablet in the form of iron salts. This high amount is not completely absorbed, and the iron ions in the intestines can irritate and damage the mucous membrane.
Supplements with lower dosages of up to a maximum of 21 mg of iron are more beneficial, as they don’t overload the cellular iron transporter ferroprotein. In addition, supplements that provide iron from plant sources are generally better tolerated than iron salts.
4. ZINC – The unexpected deficiency
Most people only think of zinc when it comes to fighting a cold. However, sources of this mineral are somewhat limited. Although overt zinc deficiency is uncommon in North America, evidence suggests that zinc intake is inadequate in certain subgroups. Surveys found that 35%–45% of adults aged 60 years or older had zinc intake levels below the estimated average requirement. Food preferences may augment the shortfall of zinc. If, for example, poultry, fish, or dairy products are preferred over red meat, the risk of zinc deficiency increases.
The trace element zinc is involved as a cofactor in the function of more than 300 enzymes. Hormones, such as testosterone and insulin, also require a sufficient supply of zinc. It has recently been discovered that zinc is particularly important for gene expression (i.e., for the conversion of genetically stored information into actual protein molecules).
Zinc has a strong relation to chronobiology. It stabilizes a protein that acts as a clock that controls the circadian rhythm; it’s not surprising that zinc readings are subject to circadian fluctuations. For example, zinc concentrations in the blood increase from morning to evening. For this reason, tests should be carried out at the same time of day.
Signs and symptoms of inadequate intake
Wound healing disorders; acne, dry scaly skin, hair loss; changes in smell and taste; growth and fertility disorders.
Risk groups
- Children and young adults: In the growth phase, a large amount of zinc is needed for physical development and sexual maturation. Unfortunately, some foods with particularly high zinc content, such as organ meats, red meat, and crustaceans, generate little enthusiasm among this target group.
- Vegetarians, vegans, and flexitarians: Those who follow a predominantly plant-based diet consume very little zinc. While there are some health advantages to lowering intake of red meat, or omitting it altogether, doing so makes it more difficult to get an adequate supply of zinc.
- Women: The reason women tend to have lower zinc levels is still unclear; however, some believe this is because women might eat less meat.
What should I do if I have a zinc deficiency?
Maintaining a varied, mixed diet will usually provide a good source of zinc. Good sources include red meat, organ meats, legumes, and grains. Oysters contain the most zinc, but they are rarely eaten on a daily basis. It should be noted that zinc from plant foods can be bound to phytic acids and tannins, which reduce its bioavailability.
Good supplementary products, such as zinc gluconate, zinc citrate, zinc bisglycinate, and zinc picolinate, provide organic zinc compounds that are readily bioavailable. High-quality supplements also contain zinc malate, the so-called apple-zinc, which is a well-tolerated compound of zinc and malic acid.
Note: Some people are sensitive to zinc and should take their supplement in the evening because this is when it is best tolerated—this is likely due to the circadian rhythm.
5. POTASSIUM – Hardly known, yet so essential
Unnoticed by the general public and even by health-conscious individuals, potassium is officially labeled as a “shortfall nutrient.” National surveys in the U.S. show that the vast majority of the U.S. population does not meet the recommended daily intake for potassium. In fact, less than 3% had a potassium intake above the recommended 4,700 mg/day. This shortfall is presumably the result of low consumption of fruits and vegetables, which are the main sources of potassium.
Potassium is an essential mineral and an important electrolyte. Normal body function depends on tight regulation of potassium concentrations both inside and outside of cells, allowing the conduction of electricity and the exchange of information in the form of nerve signals. Potassium deficiency is implicated in the development of cardiovascular disease and high blood pressure.
Signs and symptoms of inadequate intake
High blood pressure, abnormal heart rhythms, fatigue, muscle weakness, cramps, constipation.
Risk groups
- People who consume mainly meat and meat products: Fruits and vegetables are the main sources of potassium; you need to eat a lot of them for adequate potassium intake. If your diet contains more meat than vegetables, it might be difficult to get enough potassium. Another thing to consider is that high sodium consumption aggravates the situation because it induces potassium loss through the urinary tract.
- People in hot climates, individuals with labor intensive jobs, and athletes: Potassium is lost through sweat. High potassium excretion through sweat negatively influences performance and wellbeing due to an impaired electrolyte balance.
- People with low magnesium intake: Insufficient intake of magnesium can cause potassium deficiency by increasing potassium loss via the kidneys and reducing retention of potassium in the cells. A magnesium supplement is often necessary to protect adequate potassium levels in the body.
What should I do if I have a potassium deficiency?
A well-balanced diet should meet the daily recommended intake of potassium. Some fruits and vegetables—like bananas, avocados, spinach, and potatoes—are especially good at providing potassium. However, to be on the safe side, it’s recommended that most Americans supplement with potassium regularly. High-quality nutritional supplements contain potassium citrate, potassium chloride, or potassium gluconate in small doses that are time-released throughout the day. A combination of potassium and magnesium might bring additional health benefits, as these minerals act interdependently.
Important information for people on medication
While some medications require the need for higher potassium intake, others do not. If you are taking any form of medication, taking potassium supplements should be discussed with your doctor.