Do I Have a Nutrition Deficiency?
If I had a dollar for every time an athlete walked into my office unknowingly with some form of nutrition deficiency, I could retire early.
Believe it or not, this is all too common among the athletic population, especially those competing at a high level. If there is one thing I could shout on the rooftop (dance a little) and then yell, it would be this: Just because you are in great physical shape on the outside does not mean your physiology on the inside is up to par. You do not have to be half-dead in a hospital bed in order to have multiple vitamin and mineral deficiencies! In fact, many athletes silently suffer for years because they attribute their symptoms to the demands of their sport.
The Challenge of Understanding Nutrition Deficiency
As a Registered Dietitian (RD), we are often taught in school that if an individual is consuming a balanced diet, there is no need for dietary supplementation and the risk for deficiencies is slim to none.
Trust me, I wish more than anything that this was true! It would simplify my job exponentially.
Unfortunately, this is not real life, especially not for an athlete. Why do I say this? Well, for starters, the term “balanced diet” is all relative. The nutrition plan that works best for me is not necessarily what is going to work the best for you and the demands of each sport will dictate the type and dosage of nutrients for each athlete. For example, an athlete playing a contact sport such as hockey or football will typically require more Omega 3 than a cross-country athlete or swimmer. Additionally, there are many situations in life that impact digestion and absorption, and usually not for the better.
Sometimes the circumstance is plain and simple: an athlete travels often or has very little time to eat quality food. The athlete then relies on heavily processed, convenience items to get them through the day which in turn leads to nutrient deficiencies.
Another basic situation: the athlete’s training demands are so high, that they cannot possibly get every single nutrient they need through food alone. Other times the situation is more complex. For example, the athlete may be taking certain medications that interfere with nutrient absorption, they may have a genetic component where they do not metabolize certain nutrients the way that they should or the athlete could (unknowingly) be living in a toxic environment where an exposure issue is interfering with their body’s ability to receive optimal nutrition.
The Medical Community Has Some Catching Up To Do
If you haven’t figured this out by now, it is absolutely my passion in life to help people feel and perform better through diet changes and appropriate supplementation when necessary. There is nothing that frustrates me more than when an athlete goes to see their physician for an issue such as fatigue, joint pain, gastrointestinal upset, headaches, recurrent injury, etc. etc., and their physician tells them the issue has nothing to do with food. What!? Is that a joke? There are many situations where the individual’s symptoms have EVERYTHING to do with food and nutrition, or lack thereof.
Newsflash: approximately 77% of our immune system lies in our gut, hence why food can play such a major role in the way that we feel each day.
So, before you go spend hundreds, maybe even thousands of dollars on testing and before you wait around in your doctor’s office for 3 hours, I am going to teach you how to evaluate yourself for possible nutrition deficiencies.
START WITH FOOD
Before you begin consulting with Dr. Google about the strange symptoms you are having, pay close attention to the way you feel after you eat. Sometimes food allergies or food sensitivities can actually be the culprit instead of an actual deficiency or condition that has yet to be diagnosed. You may be suffering from a food allergy if you notice an immediate, anaphylactic-type reaction after eating. Examples include but are not limited to swelling of the lips or eyes, hives, and closing of the throat.
A food sensitivity is more of a delayed reaction. Symptoms do not typically appear until hours or even days later, they also tend to be chronic but less severe than a food allergy. Examples include but are not limited to headaches, fatigue, joint pain or stiffness, bloodshot eyes, dark circles under the eyes, brain fog, dizziness, difficulty sleeping, chronic throat clearing, frequent sore throat, sores on gums, lip and tongue, post nasal drip, ringing ears, sinus congestion or excess mucus production, irregular heartbeat, acne, eczema, psoriasis, excessive sweating, – these can all be food mediated reactions!
EXAMINE YOUR BODY
What does your bone health look like? Have you ever had a DEXA scan? Have you ever been told you have osteopenia or osteoporosis?
Bone health is directly correlated with gut health. Think about it, if your body isn’t receiving all the vitamins and minerals that it needs on a daily basis, your bones do not have the nutrients they need to maintain their composition and strength.
Athletes with gut-related conditions such as Irritable Bowel Syndrome or Celiac Disease are at greater risk for poor bone health. Athletes taking medications such as Glucocorticoids or Proton Pump Inhibitors are also at greater risk. Fun Fact: You can still experience nutrient malabsorption even if you have zero gut related symptoms.
Do you have the strength you’ve always had? Are you struggling to gain or maintain mass despite great efforts with diet and training? Similar to bone health, the integrity of our muscles directly relates to our gut health.
If you are not properly digesting and absorbing your food, especially protein, your muscles may suffer. Just because you are eating appropriate amounts of protein does not mean your body is making proper use of that protein. If you bloat or experience pain after meals, specifically protein-rich meals, talk to your dietitian about pancreatic enzymes or digestive enzymes, particularly hydrochloric acid.
Adequate intake of polyunsaturated fatty acids, Vitamin D, and antioxidants also play a critical role in muscle health. Fun fact: there is research to show that apple and green tomatoes have the ability to preserve muscle! Apples contain ursolic acid and green tomatoes contain tomatadine, two components that have shown to improve muscle mass by 10% and muscle strength by 30%! Research: look up Ebert SM, Dyle SC, “identification and small molecule inhibition of an ATF4 dependent pathway
Did you know that nerve endings from your organs are actually attached to your skin!? This is why you might notice a flare of acne, eczema, psoriasis, hives, rosacea, alopecia, and vitiligo at times of high emotional stress, or at the peak of your season. This is also why you might experience excess sweating when you are nervous or your hair may stand up on your skin when you find yourself in an uncomfortable situation. Take an even deeper look at your skin. Slow wound healing, dermatitis, numerous sunspots or discoloration can all be signs of insufficient fatty acid intake.
Extra wrinkles? Research shows the more wrinkles we have, the lower the bone density. This is likely a result of a loss of collagen. ( the endocrine society June 6, 2011) Low vitamin K 2 status has also been associated with more wrinkles and less bone density!
Research shows that as little as a 2% decrease in body weight due to dehydration can negatively impact performance. A 5% loss of body weight is considered mild dehydration, a 10% loss is considered to be moderate dehydration and a 15% loss is considered to be severe dehydration.
If you don’t have access to a scale, take a look at your hand, palm side up. Push your thumb into the fattiest part of your palm below your pinky. If your skin takes a little while to come back, you are experiencing dehydration. Next, flip your hand back over and press down on a couple of your fingernails. They should turn white very momentarily and then immediately come back to their normal color. If this reaction is delayed, you are likely experiencing dehydration.
The eyes are a fascinating organ because deficiency or disease often appears in the eyes before anywhere else in the body. Watch out all you soda drinkers out there! Excess sugar, particularly in the form of soda can actually narrow retinal arteries.
Dry eyes can be a sign of Vitamin deficiency, an autoimmune condition or oxidative stress for all you over-trainers out there. Little white bumps inside your eyelids can be suggestive of oxidative stress as a result of lipid peroxidation. This means that your body may be under such significant physical or mental stress that in the process, free radicals “steal” electrons from the lipids in your cell members and this causes damage at the cellular level. These bumps can also be suggestive of bacterial overgrowth and inflammation.
Open those jaws nice and wide. Now, here are the things to consider:
- Abnormally bad breath? This can be a sign of a fungal or bacterial infection. Reflux, respiratory infections and bad bacteria that has overgrown in your gut can also be the culprit.
- Raw, red tongue? This might mean you have a raw, inflamed gut. An inflamed ileum and gastric ulcers might suggest B vitamin deficiencies.
- A yellow or white coated tongue may suggest yeast or bacteria overgrowth. Fissures or jagged lines in the middle of the tongue might reveal a biotin deficiency.
- If taste buds have atrophied, this can indicate a B12 or iron deficiency. Candida, or thrush may suggest a B12, B2 or iron deficiency.
- A geographic tongue may suggest food allergies, chemical sensitivities, excess intake of alcohol or spicy foods, B Vitamin or Zinc deficiency.
- Loss or decrease in ability to taste or smell? Think zinc, vitamin A, or B12 deficiency. It may also be a result of food sensitivities.
Last but not least, since I’ve mentioned B12 quite a bit in this post, I think it’s worth mentioning the most common signs and symptoms of a B12 deficiency. These symptoms include depression, fatigue, poor memory, numbness, and tingling. Other common signs include vitiligo (light-colored blotches on the skin), hyperpigmentation (dark patches of skin), angular stomatitis (red inflamed cracks at the corners of your mouth), and skin lesions.
Have you ever had your B12 tested and it was sky-high? This can actually be a sign that your cells are not properly utilizing the B12 that you are ingesting. Speak with your doctor or dietitian and he or she will help you find the right dose and form of the vitamin.
OK. That was a lot to digest (pun intended). So what can you do going forward?
Step 1: Keep a detailed food journal for two weeks. Take note of how you feel after meals both immediately after the meal as well as in the days following. If you have a sluggish day, it could be liked to food you ate up to two days prior. The journal will allow you to start to draw patterns between what you are eating and the symptoms you are experiencing. The goal is to feel energized and symptom-free after meals. If this is not the case, consider removing that particular food(s) out of your diet for a few weeks. Make note of any improvements.
Step 2: Start with basic supplementation. Even if you think your diet is excellent, there is a good chance you would benefit from basic professional grade supplementation that is also NSF Certified for Sport. This means that you would be choosing a quality supplement that does not contain dyes, additives or fillers. It also means your supplement has been third-party tested for banned substances and what you read on the back of the label actually matches what is inside the container. One of the absolute best companies on the planet that meets both of these standards is Klean Athlete. I recommend for my athletes to take the Klean Athlete multivitamin (it contains Vitamin D!) and Klean Athlete Omega 3.
More Awesome Reading:
- Esper, DH. Utilization of nutrition-focused physical assessment in identifying micronutrient deficiencies. Nutrition in Clinical Practice. 2015;30(2): 194–202.
- Fawcett et al. Nail Abnormalities: Clues to Systemic Disease. Am Fam Physician. 2004;69:1414-1424.
- Rahvar M. and Kerstetter J. Cutaneous manifestion of gastrointestinal disease. J Gastrointes Oncol. 2016;7(Suppl1): S44-S54.
- Tarakji B et al. Relation between psoriasis and geographic tongue. J Clin Diagn Res. 2014;8(11):ZE06-7. Doi: 10.7860/JCDR/2014/9101.5171. Epub2014 Nov 20.
- Rajendran, K. et al. Can Fam Physician 2008 April; 54(4):529-532
- Collagen/Vit K/Bones:The Endocrine Society June 6, 2011
- Mol Nutr Food Res. 2014 Aug;58(8):1647-57
- Ebert SM, DyleMC, Bullard SA, DierdorffJM, MurryDJ, Fox DK, BongersKS, Lira VA, MeyerholzDK, Talley JJ, Adams CM. Identification and Small Molecule s of an ATF4-dependent Pathway to Age-related Skeletal Muscle Weakness and Atrophy. J BiolChem. 2015 Sep 3.
- Canadian Journal of Applied Physiology, 1999, 24(2): 164-172, https://doi.org/10.1139/h99-014.