Ten Need-to-Know Factors That Influence Nutrient Status

Our patients and website readers are always asking whether they should be taking supplements, including what type, and at what dose. Often missed in the information put out by Dr. Google is the fact that what each person needs is unique. In our experience, individuals who are trying to do the right thing with micronutrient support can end up on very extensive (and expensive!) supplement programs. What we love about functional medicine is that we are able to lean on food for nutrients as much as possible. And that we have the tools to look under your “metabolic hood” as it were to identify optimal levels for consumption for each person, supplemented only where necessary. It’s a powerful and satisfying model for both patient and practitioner.

Do you want to know what nutrients you need and at what doses to achieve optimal health? Read on to learn how we view this all-important question in our practice. – DrKF

“Micronutrients” is the term used to describe essential dietary vitamins and minerals. These are nutrients that cannot be made in our bodies and so have to be consumed in our diets. There are also several amino acids (protein building blocks) and fatty acids that are essential (these are considered “macronutrients” since they make up protein and fat intake, of which we need greater quantities compared to “micro”nutrients), as well as a host of non-essential small dietary molecules such as phytonutrients, lipoic acid, coenzyme-Q10 and more that are vitamin-like and can be helpful to source in our diet if our internal production of these compounds is below optimal. 

Getting enough of these nutrients may seem straightforward, but there are actually many nuances in determining how much of a nutrient we need and many different factors beyond dietary intake that can influence nutrient status. Even if you are watching what you eat, and “covering your bases” with a multivitamin, chances are you can do more if you truly want to optimize your nutrient status and overall health.

Read on to understand more and discover 10 factors that influence your body’s nutrient levels.

 

What do Nutrients do for Us?

Here are just some of the wide-reaching, important roles nutrients play in our bodies:

• Energy production: The production of ATP (adenosine triphosphate), the energy “currency” of cells, requires essential vitamins such as riboflavin (vitamin B2) and niacin (vitamin B3) as well as some non-essential (or conditionally essential) nutrients like lipoic acid and coenzyme Q10. Energy is essential for most cellular activities and can therefore promote dysfunction and disease when it’s lacking. 
• Building and repair processes: Either as building blocks (think calcium and magnesium in bones, or amino acids in all the different proteins like enzymes, hormones, and neurotransmitters) or enzymatic cofactors (vitamins D, C, K and more for bone formation too, selenium, iodine, and more for thyroid hormone). 
• DNA synthesis and repair: Our cells are continually dividing and renewing and each time they do that DNA must be synthesized and its epigenetic pattern copied to the new DNA. Methylation nutrients like folate, B12, and more, play essential roles in this process.
• Cell signaling and communication: Certain nutrients, such as antioxidants and phytochemicals found in fruits and vegetables, contribute to cellular signaling and communication. They facilitate and regulate various processes, including our inflammation and immune response, and ensuring proper coordination between cells. 
• Maintaining cellular homeostasis: Electrolytes obtained from food, such as sodium, potassium, and magnesium, play a crucial role in maintaining cellular homeostasis. They help regulate osmotic balance, nerve impulses, and muscle contractions. 

 

BTW, Your Optimum is Different to Mine

What do we mean by optimum nutrient status? Can I just use the Dietary Reference Intakes (DRIs) to guide my nutrient consumption?

These are fundamentally important questions, which illustrate how functional medicine thinks differently about nutrient status. By reviewing what we mean by “optimal” vs “adequate” status, as well as how that compares to marginal and frank deficiencies, we can better understand why there’s more to know and why we can’t rely on DRIs alone:

• Optimal status: Beyond simply avoiding disease, optimal nutrition status aims to provide the best nutrient level to achieve the best possible metabolic, organ, and body function. Functional medicine practitioners lean strongly into nutrient status optimization both to reduce disease as well as to promote optimal health and longevity. This is where we want to focus.
• Adequate status: Dietary guidelines provide reference intakes in the form of Recommended Daily Allowances and Adequate Intake amounts that are based on healthy populations in order to avoid frank deficiency symptoms and diseases. In recent years, these guidelines have been evolving to try to also prevent chronic disease, but they are not focused on individual optimization and do not take into consideration varying needs beyond very broad categories (male/female, age, pregnancy). They are focused on nutrient intake alone rather than functional nutrient status in the body, which can be affected by many factors (more below). Compared to these guidelines, general nutrient shortfalls are still relatively common even in the United States and other more developed countries.
• Marginal deficiency/depletion: Nutrient status below adequate levels that may not result in frank deficiency symptoms and diseases but nevertheless may compromise metabolic, organ and body function. Functional medicine focuses on identifying and correcting marginal deficiencies in a way that conventional healthcare usually does not. There are some exceptions for some basic nutrient testing such as for iron (serum iron, ferritin, and transferrin saturation) or vitamin D (25-hydroxyvitamin D) levels that are much more likely to be considered in conventional care, although with different considerations for what is “optimal,” especially for vitamin D. 
• Deficiency: These days, frank deficiency diseases such as scurvy (vitamin C deficiency) or rickets (vitamin D deficiency) are fortunately rare in developed countries. As deficiency diseases have diminished and the wider focus has shifted to chronic disease care, attention has started to shift to marginal deficiencies and optimal status, with functional medicine leading the thinking. 
• Toxicity: It’s still very much possible to have “too much of a good thing.” Dietary reference intake guidelines include Tolerable Upper Intake Level (UL) guidelines that are designed to prevent toxicity from excess intake in most people. However, this sometimes has to be tailored further still – for example, iron even within “recommended” levels can be too high for some individuals such as those with hemochromatosis. And sometimes it may be necessary to go above UL guidelines temporarily in certain repletion circumstances or where nutrient losses are exceptionally high, and under the guidance of a knowledgeable and qualified healthcare professional.

Here’s an example of some of the nutrient intake analysis from our clinic files. Read on below for what else influences nutrient status.

10 Factors that Influence Nutrient Status – Some May Surprise You

1. Nutrient Intake: This is where most of us tend to focus when it comes to nutrient status – how much of any given nutrient are we consuming? And it is an important question, even as it’s not the only one – it is why our functional-medicine trained nutritionists regularly conduct Nutrient Intake Analyses to estimate current intake. Nutrient intake is influenced by the nutrient density of the foods we’re choosing and the variety of foods that covers all necessary nutrients. Nutrient density itself is also affected by the quality of the soil the food is grown in, how food has been stored and transported and for how long, as well as processing, including cooking. Combinations of nutrients can also alter each others’ absorption – vitamin C increases iron absorption and fats increase the absorption of phytonutrients, for example.

2. Dietary antinutrients: The absorption of minerals, such as iron, calcium, iodine, and zinc, is influenced by the presence of inhibiting factors in the diet. You might have heard of some of these so-called “antinutrients” – goitrogens, phytates, and tannins. Soaking, fermentation, sprouting, and cooking tend to decrease the effects of these compounds, making them of low concern to most people. However, their effects can be relevant in some circumstances.

3. (Safe) Sun exposure: Not all vitamins can be found in food! Vitamin D is an essential hormone-like nutrient that is only found in small amounts in certain foods and is predominantly sourced by exposing skin to adequate ultraviolet B (UVB) rays. Living in northern latitudes as well as spending too much time indoors (as many of us do) can lead to inadequacy or even deficiency of this vitamin. 

4. Digestion and absorption: Foods must be broken down sufficiently such that the nutrients they contain can be absorbed. All stages of digestion play a role here, from the enzymes in saliva, the mechanical action of chewing, to stomach acid, to the release of bile and pancreatic secretions, to brush border enzymes in the intestines, and even some activity in the colon. Our digestive and absorption systems can be affected by different conditions as well as simply by age. They also function better when we are in “rest and digest” mode instead of “fight or flight.” A good medical history, symptoms review, and (where indicated) a comprehensive stool analysis that includes markers for different areas of digestive function, are common ways to evaluate digestion and absorption in functional medicine. Adrenal function tests may also be relevant.

5. Cellular uptake: Once nutrients are absorbed they enter circulation and, for the most part, must be taken up into cells in order to be utilized. Many nutrient assessments look at plasma or serum levels which can be useful information in some circumstances (especially when those levels are low), but this doesn’t tell you how much of that nutrient is getting into cells. Red blood cell nutrient content (such as for zinc, magnesium, or selenium) is one way to look at intracellular levels. We can also use functional tests (such as for methylmalonic acid or formiminoglutamate and other biochemical pathway intermediates) to infer levels of nutrients used in those pathways – these give some of the best indications of whether we actually have enough of a particular nutrient when and where the body actually needs it.

6. Microbiome: Beneficial microbes in our digestive system produce several essential nutrients for us – especially B vitamins (including folate and biotin) and vitamin K – in amounts that are physiologically relevant to maintaining nutrient status. An imbalanced (dysbiotic) microbiome may alter nutrient absorption, such as is the case with iron and zinc. Comprehensive stool tests, along with urinary organic acids, help us evaluate the health of the microbiome. 

7. Lifestyle: High levels of physical activity and heat exposure that induce sweating can increase the need for electrolyte minerals such as sodium, potassium, magnesium, calcium, and chloride. But not everyone needs additional electrolytes. Chronic stress may lead to increased need for B vitamins, vitamin D, vitamin C, magnesium and zinc to maintain healthy levels. These and other lifestyle variables impact our need for different nutrients.

8. Environmental exposures: We live in a world where our bodies are invariably challenged with potentially-toxic substances. While we do have some capacity to detoxify and eliminate harmful substances, this capacity varies considerably from one individual to the next. And those exposures and tolerances alter nutrient need. Some nutrients help with toxin elimination but are “spent” in the process – this is the case with selenium, for instance, in its detoxification of mercury and fungal toxins. Counteracting lead exposure is another example where a more steady and sufficient intake of calcium is important to inhibit lead absorption.

9. Disease: Not only do nutrient insufficiencies play significant roles in the onset of disease, but both acute and chronic diseases alter nutrient absorption and utilization, changing the requirements for consumption. Acute infections, for instance, increase the utilization of vitamin C and glutamine. Chronic conditions often affect nutrient digestion, absorption and cellular uptake. Diseases of the digestive tract, such as atrophic gastritis and Crohn’s disease inhibit the breakdown and absorption of a wide range of nutrients. Hypothyroidism and excess alcohol intake reduce nutrient digestion, absorption, and alter nutrient metabolism as well. Last but certainly not least, functional medicine practitioners often use targeted dosing strategies in the context of certain conditions and diseases.

10. Medications: The science of drug-nutrient interactions is quite well established at this point, even as it isn’t as widely used as it should be in conventional medicine. Many drugs can, when used long term, deplete certain nutrients. Metformin, commonly used for type II diabetes, is known to deplete vitamin B12. Diuretics deplete vitamin B1, magnesium, potassium, and zinc. Corticosteroids deplete calcium and potassium. You can look up the potential nutrient depletions associated with pharmaceuticals you may be taking here: https://lpi.oregonstate.edu/mic/drug-nutrient-interactions 

Functional medicine practitioners consider all these different areas with all patients that they work with. Understanding the broader landscape of factors that influence nutrient status means that recommendations will vary, often quite a bit, from one patient to the next. Food is the ideal source for nutrient repletion and optimization, however targeted supplements are useful where nutrient needs cannot be met with food alone.

If you’re interested in working with one of our practitioners to optimize your nutrient status and meet your health goals, please contact us here.

Useful Nutrient Resources from DrKaraFitzgerald.com

Potassium – The REAL Special K+

Potassium: The Little Element that Could (significantly reduce the cost of the global medical crisis)

Leaning on Dietary “Anti-Nutrients” for Treatment of Iron Overload

Folate – Perils, Possibilities, and Practical Advice

Autism and Cerebral Folate Deficiency

Role of Fat-Soluble Vitamins A and D in the Pathogenesis of Influenza: A New Perspective