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While many countries worldwide have made significant progress regarding access to clean water, sanitation, vaccination rates, nutrition, reduced infant mortality, lifespan extension, and healthcare technology, many still lack the basics. Most of these deficiencies affect countries with a low GDP or Gross Domestic Product, where most citizens live in poverty.
Malnutrition can result from the deficiency of two types, macronutrients and micronutrients.
Macronutrients include protein, fats, and carbohydrates which are required for overall health and survival. Essentially, every food we eat consists of these three things in various proportions.
Proteins are made of amino acids and are the building blocks of our muscles and enzymes. Some are termed "essential," meaning we can only get them from the diet. Others termed "non-essential" our body can make.
Fat is required for brain health, cell integrity, and hormone synthesis. Certain fats are called "essential fatty acids" as we can only get them from the diet.
Lastly, there are carbohydrates, which ultimately break down into glucose to fuel the body. Ironically, these are not essential as the body can make glucose from amino acids and protein when not in the diet. Carbohydrates high in fiber (i.e., kale, greens) are not broken down into glucose. However, starchy carbohydrates ( i.e., potatoes) can easily break down into glucose.
Micronutrients are vitamins and minerals needed by the body. They can't be made and must be consumed. When deficient, one can develop life-threatening health issues. Many trace minerals help the body's hormones and enzymes to function normally.
According to the World Health Organization (WHO), 45% of deaths in children worldwide are due to nutritional deficiencies. Third-world countries are the most affected.
A deficiency of macronutrients (protein, fats, and carbohydrates) leads to muscle wasting, a deficiency in the below micronutrients is also the main contributor to poor health and is what we will discuss in this blog.
Worldwide, folate, vitamin A, iron, iodine, and zinc are some of the most common deficiencies. Fortunately, they are also some of the most inexpensive nutrients and easiest to replete, so ensuring adequate intake can be done if a concerted effort is put in place.
Folate is an important water-soluble vitamin for healthy cell division and proper nerve development. It is required to produce DNA, RNA, and amino acids adequately. Folic acid is a common form of vitamin B9 that is added to multivitamins and food. The word folate is derived from "foliage," a reference to green leafy vegetables and plant foods, where folate is found in abundance.
In the United States, up to 20% of teenage females do not get adequate amounts of folic acid. A 2017 European Journal of Clinical Nutrition study suggested up to 85% of women in the United Kingdom aged 16-49 are at risk for deficiency. Men and women from Asia, Europe, Africa, and the Middle East are at greater risk.
Maternal intake of folic acid may reduce the risk of autism in babies, according to a 2018 study in JAMA Psychiatry. Prenatal vitamins contain folate and, when taken, can help prevent neural tube defects and cleft lips and palates in babies. According to many health professionals, women of childbearing age should take folate routinely.
When the diet does not provide sufficient folate, folate or folic acid supplement should be considered. This is especially important in women of childbearing age. It can be consumed as an individual supplement, part of B-complex vitamin, or as part of a quality multivitamin or prenatal vitamin. The minimum dose is 400 mcg, and rarely is a dose of more than 1,000 mcg recommended. This is extremely important in pregnant and nursing mothers to help ensure the children have sufficient levels.
Vitamin A is a powerhouse nutrient, yet it is the most common vitamin deficiency worldwide. It is a potent antioxidant that comes from two sources. In certain plants, there is beta-carotene, a precursor to vitamin A. The body then converts this to vitamin D. In meats, there is pre-formed vitamin A, which is ready to use once consumed.
When vitamin A is lacking in a person's diet, the results can be catastrophic, especially in children. Vitamin A is crucial for developing healthy vision, immune system strength, and future reproduction. According to WHO, more than 250 million preschool-aged children worldwide are deficient. Further, blindness due to vitamin A deficiency affects 2.8 million children under five. When one is deficient, the cornea becomes dry, resulting in cornea and retinal damage.
Women who are pregnant and deficient in vitamin A are at risk for night blindness, while the fetus without sufficient levels of vitamin A in the mom is at risk for developmental issues.
Many plant-based foods contain beta carotene (pro-vitamin A), the precursor to vitamin A. These carotenoids, as they are called, play an important role in overall health.
Consuming adequate vitamin A from one's diet is preferred. However, this is not always possible for many around the world.
Therefore, consuming a quality multivitamin with vitamin A is essential; in some cases, a separate vitamin A supplement may be needed.
Vitamin A toxicity can occur when excessive amounts, 25,000 IU daily or more, of preformed vitamin A, are consumed. Cod Liver oil is also a great source of vitamin A.
Beta-carotene has no known toxic effects or upper limit when eaten as a food. However, when large amounts are consumed, some can develop a reversible orange color in their skin, a condition called beta-carotenemia. This is reversible when intake is reduced.
NOTE: Smokers should be extra cautious about supplementing with vitamin A alone as it may increase lung cancer risk, according to some studies. Consult a physician first.
Iron is the most abundant mineral on earth. It is a chemical element with the periodic table's Fe (ferrous) symbol. However, the average person has only 3-4 grams (1 teaspoon) in the body, most of it in hemoglobin. The rest is in the muscles, bone marrow, liver, and spleen. Despite this relatively small amount in the body, iron deficiency anemia is estimated to affect two billion people worldwide, mostly women and children.
Iron is crucial for the production of hemoglobin, which, when low, a person is diagnosed with iron-deficient anemia. Low iron in children can result in growth retardation.
Iron in animal-based foods is better absorbed and is known as heme iron. Iron from plant-based foods is called non-heme iron.
As long as the mother is not deficient, breast milk usually contains enough iron for a growing baby up to 6 months of age. Children not breastfed should consume iron-fortified formula. Ensuring the mother takes a multivitamin with iron is one of the best ways to ensure a breastfeeding child receives adequate nutrition.
If not breastfed, the WHO (World Health Organization) recommends supplementation with 2 mg/kg/day in children from 6 to 23 months of age if the diet does not already include fortified foods or if they live in a developing nation where the prevalence of anemia is 40% or more.
Young children and adults should consume iron-rich foods, including meats, poultry, and green leafy vegetables, if possible. A multivitamin with iron or a separate iron supplement should be considered if not possible.
According to the Journal of Nutrition, almost 45% of Americans have inadequate zinc intake in their diets. Worldwide, more than 15% of people are zinc deficient. Children are adversely affected to an even greater degree.
Zinc also plays a vital role in brain health, where its levels are ten times greater than in the blood. Enzymes require zinc in the brain and throughout the body. Zinc is involved in over 300 biochemical reactions and is a critical component of over 2,000 proteins.
The below foods (per 3 grams) are some of the richest sources of zinc. For obvious reasons, many of these foods are not easily accessible worldwide or may be culturally inappropriate.
Ideally, zinc should be consumed by eating more of the foods listed above. However, that is not always possible. In that case, supplements should be considered. Zinc supplements come in many forms, including Zinc Picolinate, Zinc Gluconate, Zinc Bis-glycinate, and Zinc Citrate – these are the best absorbed. The usual dose is 10 mg to 25 mg daily. A quality multivitamin with zinc can also be considered.
Iodine is an essential trace mineral. Iodine is represented by the Symbol I on the periodic table. In addition to thyroid function, iodine has many other important roles in human health. Iodine deficiency disorders affect 740 million people worldwide, making it one of the most common.
Increasing the consumption of eggs and dairy products such as milk, yogurt, and cheese can help ensure the intake of iodine.
Using iodine-fortified salt for flavoring is also helpful. Sea vegetables such as kelp, dulse, and nori are rich in iodine. Fish such as cod and tuna are also great sources of iodine.
When this is not possible, a multivitamin with iodine should be consumed. Infants to six years of age need a minimum of 90 mcg per day- if a mother is breastfeeding, supplementation can help meet these needs. Children ages 6 to 12 need 120 mcg per day. Those 13 and older need at least 150 mcg of iodine, which is common in most multivitamins. Pregnant and lactating women need about 300 mcg daily, about double the recommended adult dose.
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By Dr. Eric Madrid, M.D.
