The Evolving Picture of Nutrition – Integrative GP, Dr Joe Kosterich
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It would be nice to think we could achieve all our nutrient needs from food – however modern life, illness, eating patterns, farming, transport and storage disrupts our ability to fulfill all our vitamin and mineral requirements. To add to this, there are times where nutrient needs are increased and may not be achievable by eating food alone.
These are the top reasons why supplementation may be necessary. Check with your health care professional for advice on what supplements would be suitable for you.
The Australian diet is known to be very low in vegetable, fruit, and dairy intake, and high in sodium, carbohydrate, protein and fats – and often not the good types of fats[1]. In my clinical practice using professional dietary analysis software programs, I find that there are general nutrient deficiencies in the majority of the most well-intentioned diets. A large study of developed countries identified that a significant proportion of western populations demonstrate very low (>50-75%) intake of vitamin D, E and folate, and other lesser percentage deficiencies found were that of vitamin A, B1, B2, B 6 and vitamin C. In Australia, the most common nutrient deficiencies are iodine, zinc, selenium, vitamin D, calcium, iron, and indications for low omega 3.[2][3][4]
Most food is transported; food is stored on trucks, in refrigeration and then left in stores for many weeks before being consumed. Nutrients in plant foods rapidly decrease in this time. Storage and aging of fruit and vegetables leads to higher fructose and lower nutrient content. The greatest antioxidant nutrient loss occurs with storage over a period of 8 months to 18 months, which is common.[5]
Cooking processes commonly see the loss of both B1 and Vitamin C. Food cooking methods can also encourage the loss of protein, chlorophyll and cause significant losses of B complex vitamins. For example, broccoli can sustain loss of 10-30% of its vitamin C through boiling, frying and microwaving.[6][7][8][9]
Low calorie and fad diets may reveal low nutrient intake through lack of variety and nutritional knowledge.[10] Any restricted diet and particularly those seen with gastric banding, will cause a reduction in essential nutrients, such as calcium magnesium, iron and vitamin D.[11]
Senior researcher from CSIRO, Dr Manny Noakes suggests that being overweight may not protect a person from malnutrition; this is largely due to a lack of nutritious choices made in food selection.[1]
Compared to grass-fed meat, grain-fed meat is lower in antioxidants, micronutrients, B-vitamins, vitamin E and beta-carotene.[12]
In 2005, the content of essential fatty acids and predominately omega 3 was high enough to meet the recommended intake, if salmon was consumed twice a week. Due to modern fish farming, it was found in 2015 that consumers would need to eat twice as much fish to reach the recommended levels of omega 3 intake, taking this to four serves of fish per week. Alongside this is a rise in the intake of omega 6 which is already abundant in the western diet and may cause other health issues.[13][14]
Illness, sport, stress, pregnancy and lactation can all increase the need for higher nutrient intakes. Supplemental iron, folate, iodine, zinc, calcium, magnesium, vitamin D, C and B12 are commonly suggested to assist health in times of extra demand.[15]
Under nutrition in the aged is common in the developed world and can be the consequence of many reasons, including physical, mental and financial constraints. Common nutrient deficiencies in the older population are B1, vitamin C, vitamin A, and nicontinamide.[16] Polypharmacy (intake of many prescriptive drugs) may also increase the need for nutrients such as vitamin D, biotin, calcium and B6 where supplementation may be necessary.[17]
More than one in 10 people (male and female) on gluten free diets have inadequate folate, zinc, calcium, magnesium, vitamin A and iron intakes.[18]
Digestive issues such as inflammatory bowel disease (IBD) can cause malabsorption and therefore malnutrition. A therapeutic approach discussed in a meta-analysis of over 2,025 reviewed documents suggests that there may be a need for omega 3 supplementation, as well as pre and probiotics to assist management of IBD.[19] Leaky gut (Gut permeability) may increase both macro and micronutrient loss from the intestine.[20] Diseases associated with gut permeability in children are Celiac disease, infectious diarrhea, type 1 diabetes, atopy and allergy, and autism spectrum disorders.[20] Irritable bowel syndrome (IBS) sufferers may require additional B12, folate, calcium, selenium zinc, vitamin A, C, E and iron.[21] There are many other diseases, which affect mucosa, intraluminal tissue, and endocrine disruption that cause malabsorbative issues.[22]
References available on request
Teresa Mitchell-Paterson ADV DIP NAT, BHSc Complementary Medicine, MHSc Human Nutrition, has a clinical history in Integrative Naturopathy spanning over twenty years. She is an educator of final year clinical studies for Bachelor of Health students (Naturopathy and Nutritional Medicine). Teresa has also embarked in writing for evidence based naturopathic texts and is a spokesperson and advocate for naturopathic healthy lifestyle. For the past six years Teresa has been a nutritional advisor for Bowel Cancer Australia, and Health and Medical Panelist for the Memorial Winston Trust Fund.