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The human body may only require micronutrients in small doses, but these vitamins and minerals are crucial for basic physiological functions such as metabolism, growth, and development. Deficiencies in one or more of these micronutrients may lead to detrimental health impacts, including chronic diseases. For decades, health organizations have been reporting on micronutrient malnutrition, including deficiencies in iodine, iron, folate, vitamin A, and zinc, among others, that continue to have devastating consequences for billions of people worldwide.1–5 And micronutrient deficiencies are not limited to developing nations.
Several nutrient shortfalls have been noted within the US population.6 Analysis of National Health and Nutrition Examination Surveys (NHANES) suggests that micronutrient malnutrition is common in the United States, with an estimated 31% of the population at risk of developing one or more micronutrient deficiencies.7
The “Hidden Hunger”
The term “hidden hunger” is used to describe vitamin and mineral deficiency. When someone’s habitual diet consists of foods that lack necessary levels of micronutrients, the resulting health impacts may not always be acutely visible.5 Micronutrient malnutrition has been associated with a wide range of physiological impairments, including metabolic disorders; reduced immune, endocrine, and cognitive function; and delayed or inadequate physical development.1,3,7
Some micronutrient deficiencies may also be an underlying cause of chronic disease. Magnesium, for example, is present in a variety of foods, from greens to whole grains, yet it is under-consumed in the US.6,8 Studies indicate that low magnesium intake has been associated with a greater risk of several chronic diseases, including cardiovascular disease (CVD), type 2 diabetes, metabolic syndrome, depression, and impaired cognition.8,9
Combined US reports indicate that micronutrients such as magnesium, calcium, potassium, iron, and vitamins A, D, and C are under-consumed by children and adults in the US relative to dietary guidelines for life stages and the estimated average requirements (EAR).6–8,10 The overall high-calorie, low-nutrient-density makeup of the commonly consumed Western-type diet, with more processed foods and less vegetables, is one important cause of this issue.10 Further, analyses of surveys suggest that certain populations in the US are more vulnerable to micronutrient deficiencies or may have an increased micronutrient need, including the following:7,11
- Individuals with low-nutrient diets or on restrictive diets
- People of low socioeconomic status or those experiencing food insecurity
- Women, particularly those of child-bearing age
- Black, Indigenous, and People of Color (BIPOC)
- Older adults
- Individuals with certain medical conditions or disease states
In addition, long-term users of medications may also experience interference with their body’s ability to absorb and benefit from the nutrients found in foods. Potential drug-nutrient depletions have been noted for commonly prescribed pharmaceuticals, with micronutrients such as magnesium, calcium, B vitamins (including B12 and folate), potassium, and zinc most often mentioned as potentially impacted.12
Phytonutrients are plant-based chemicals available through a diet that includes whole grains, beans, fruits, vegetables, spices, and herbs. Research suggests that these bioactive compounds, which contribute to a plant’s color, taste, and smell, also have beneficial health effects. For example, flavonoids are compounds found in cocoa, apples, and tea. Epidemiological studies have suggested a positive association between diets high in flavonoid-rich foods and cardiovascular health, while clinical trials have shown lower blood pressure results after consumption of flavonoid-rich food.13 In addition, phytochemicals such as sulforaphane and lycopene have health-promoting properties and protective effects against many diseases, including cancers.14,15 Even with the suggested benefits, according to a Centers for Disease Control and Prevention 2022 publication, only an approximate one in ten adults meet the recommendations for fruit and vegetable daily intake,16 potentially increasing their risk for developing chronic diseases such as type 2 diabetes and heart disease.
Assessment and Treatment Strategies
Evaluating nutrient deficiencies during clinical assessment is an important step in identifying this underlying cause of many chronic symptoms and conditions. Due to the essential nature of micronutrients at the cellular level, addressing one or more of these deficiencies has the potential to resolve many health issues, either in part or in total. Personalized nutrition strategies may include supplementation, new dietary habits, or structured food plans. The functional medicine model uses a framework that prioritizes a comprehensive view of a patient’s historical and current conditions, including nutrition intake and dietary patterns, to determine appropriate interventions for each individual patient. The functional medicine approach also emphasizes a practitioner-patient collaboration to fully involve the patient in their treatment plan and to provide them support during their journey to wellness.
IFM offers a number of techniques and tools for effective nutritional assessments and personalized treatment strategies that address nutrient deficiencies to move patients to better health and well-being. For example, the nutrition-oriented physical exam is an assessment tool that helps detect imbalances by conducting the physical exam through a nutritional lens. Learn more about this technique and others at IFM’s Applying Functional Medicine in Clinical Practice (AFMCP), where a team of experienced functional medicine clinicians teaches participants how to identify clues suggesting nutritional dysfunction and provides tools to help improve patient outcomes.
- Allen L, de Benoist B, Dary O, Hurrell R, eds. Guidelines on food fortification with micronutrients. World Health Organization and Food and Agriculture Organization of the United Nations. https://apps.who.int/iris/bitstream/handle/10665/43412/9241594012_eng.pdf. Published 2006. Accessed February 8, 2022.
- Thompson B, Amoroso L, eds. Combatting micronutrient deficiencies: food-based approaches. CAB International and Food and Agricultural Organization of the United Nations (FAO). http://www.fao.org/3/a-am027e.pdf. Published 2011. Accessed February 8, 2022.
- Bailey R, West Jr. K, Black R. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015;66(S2):22-33. doi:10.1159/000371618.
- Ritchie H, Roser M. Micronutrient deficiency. Our World in Data. https://ourworldindata.org/micronutrient-deficiency . Published August 1, 2017. Accessed February 8, 2022.
- Nutrition: micronutrient facts. Centers for Disease Control and Prevention. https://www.cdc.gov/nutrition/micronutrient-malnutrition/micronutrients/index.html . Reviewed February 1, 2022. Accessed February 8, 2022.
- US Department of Health and Human Services and US Department of Agriculture. 2020-2025 Dietary Guidelines for Americans. USDA and HHS; 2020. https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials.
- Bird JK, Murphy RA, Ciappio ED, McBurney MI. Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States. Nutrients. 2017;9(7):E655. doi:10.3390/nu9070655.
- Drake VJ. Micronutrient inadequacies in the US population: an overview. Linus Pauling Institute, Oregon State University. https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview. Published November 2017. Accessed February 8, 2022.
- Rosanoff A, Dai Q, Shapses SA. Essential nutrient interactions: does low or suboptimal magnesium status interact with vitamin D and/or calcium status? Adv Nutr. 2016;7(1):25-43. doi:10.3945/an.115.008631.
- Marriott BP, Olsho L, Hadden L, Connor P. Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003—2006. Crit Rev Food Sci Nutr. 2010;50(3):228-258. doi:10.1080/10408391003626223.
- Drake VJ. Subpopulations at risk for micronutrient inadequacy or deficiency. Linus Pauling Institute, Oregon State University. https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/subpopulations-at-risk. Published January 2018. Accessed February 8, 2022.
- Mohn ES, Kern HJ, Saltzman E, Mitmesser SH, McKay DL. Evidence of drug-nutrient interactions with chronic use of commonly prescribed medications: an update. Pharmaceutics. 2018;10(1):36. doi:10.3390/pharmaceutics10010036.
- Rees A, Dodd GF, Spencer JPE. The effects of flavonoids on cardiovascular health: a review of human intervention trials and implications for cerebrovascular function. Nutrients. 2018;10(12):1852. doi:10.3390/nu10121852.
- Klomparens EA, Ding Y. The neuroprotective mechanisms and effects of sulforaphane. Brain Circ. 2019;5(2):74-83. doi:10.4103/bc.bc_7_19.
- Grabowska M, Wawrzyniak D, Rolle K, et al. Let food be your medicine: nutraceutical properties of lycopene. Food Funct. 2019;10(6):3090-3102. doi:10.1039/c9fo00580c.
- Lee SH, Moore LV, Park S, Harris DM, Blanck HM. Adults meeting fruit and vegetable intake recommendations — United States, 2019. MMWR Morb Mortal Wkly Rep. 2022;71(1):1-9. doi:10.15585/mmwr.mm7101a1.