Last week I ran a nutrient intake analysis (NIA) on a couple of patients of the clinic; let’s call them Ava and Paige. In both these cases, weight loss is one of the primary goals. An NIA is something we regularly do with individuals that we work with to ensure that not only is their therapeutic diet plan dialed in to their medical needs, but that we are able to help them implement it in a way that is nutritionally replete. This can’t be understated: even a healthy eating plan can become nutritionally imbalanced if it is not implemented carefully.
What’s interesting about these two cases and NIAs? Well for one, the weight loss approach was different for each. And, when we ran the NIA, we identified similar nutrients that we needed to pay more attention to, but the remedy for each was entirely different… This is nutrition as personalized as it gets.
For Ava, a shift in her diet away from higher carbohydrate foods, avoiding identified food sensitivities, and incorporating nutrient dense, Paleo alternatives prompted a dramatic shift in her body weight. She has lost over 70 lbs so far; a phenomenal achievement! When I ran her NIA, however, her intake evaluation still showed deficiencies of calcium, folate, vitamin A, vitamin E and omega 3 fatty acids.
We already had her taking a fish oil supplement, which helped address her low intake of omega 3 fatty acids. The best way for her to meet her remaining nutrient needs was through foods. We always look to fill nutrient deficits with food before turning to supplements. To that end, we discussed a ‘personalized’ daily smoothie recipe (with calculated nutrient composition) that would make up the nutrient shortfall.
For Paige, we had to take a different approach. Paige came to us experiencing weight loss resistance. She had been on a low carb diet for quite some time but, while it had worked for a while, recently she hadn’t been able to shift any more weight. Our initial work with her concentrated on identifying other factors that could be stalling her weight loss, such as functional nutrient deficiencies, food sensitivities, gut imbalances, toxin exposure and sluggish detoxification. This resulted in some modest success, especially with other symptoms she was having such as anxiety and fatigue, but not enough to really make further weight loss tracks.
So we upped the ante and started her on a restricted ketogenic diet (3:1 ratio of fat:protein/carbs). Weight loss resumed at a steady pace, but when calories and macronutrient ratios are restricted, nutrient attention is even more important. Unsurprisingly, given the caloric restriction, Paige’s NIA was low in consumption of important minerals including calcium, iron, magnesium, selenium and zinc. B vitamin intake was also low, as was vitamins C, D and E. We always start patients on a multi when implementing a restricted ketogenic diet in anticipation of nutrient intake deficits, but after Paige’s NIA, we tweaked our supplement recommendations further to meet her where she was at with the diet. Nutrient repletion through food (except for vitamin E, found in certain fats) was not practical for Paige during the RKD, as any recommendations we would make would tip her out of ketosis.
Great post, Romilly! I’ve been experimenting with Ketogenic diets myself. Homemade bone broths, pate, seaweed snacks, mineral water and sea salt (along with supplementation) have been useful to keep nutrients up and balanced.
What testing do you use to assess nutrient status?
Nice article. I had issues with weight for quite some time. It seems like a need additional health 🙂
Hi Romilly, I enjoyed your article – wondering what computer program you are using/would recommend for the NIA?
Hi Evelyn and Sarah!
Welcome to the site. I’m glad you enjoyed the article. We use the USDA’s SuperTracker for our NIA’s. There are many options out there, each with pros and cons. And we also put that into context with lab evaluations that give us functional nutrition status, at baseline and then intermittent follow ups. Really important not to rely only on one angle.
Ps. Evelyn, I love your approaches to boosting mineral intake.