diagnosis and treatment
If a doctor believes that an individual is suffering from a lack of nutrition, the healthcare provider will weigh the individual and make a dietary assessment, which includes a diet history or food frequency analysis.
Blood tests to look for anemia, thyroid disorders, and to measure levels of specific nutrients (such as vitamins and minerals) are usually used.
Diagnosis using contrast X-rays of the gastrointestinal tract may be carried out to test for underlying digestive disorders. If the deficiency is severe, the individual will be admitted to a hospital where nutrients will be administered using a tube passed through the nose into the stomach (G-tube) or intravenously (IV) directly into the bloodstream.
Changing the diet will resolve the problem if poor eating habits are the cause. Each individual will have specific nutrient (vitamin and mineral) deficiencies, so it is important for a doctor to determine which nutrient deficiency is present. A sample of blood will generally be taken in a clinic or hospital and analyzed for vitamin and mineral status. In some cases, such as Crohn's disease (a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by affecting the entire wall of the involved bowel or intestines) or gastric bypass, long-term vitamin and mineral supplementation will be required. These conditions cause changes in the absorption of nutrients and can cause long-term vitamin and mineral deficiencies.
If medications are causing nutrient depletion, supplementation with multivitamin therapy or the depleted nutrient, such as coenzyme Q10 (with certain cholesterol-lowering medications called HMG-CoA reductase inhibitors), is recommended by healthcare providers. It is recommended to discuss any interactions with medications or dietary supplements with a healthcare provider.
Nutritionist: A nutritionist is a health professional dedicated to food and nutritional science, preventive nutrition, diseases related to nutrient deficiencies, and the use of nutrient manipulation to enhance the clinical response to human diseases. Nutritionists evaluate the diets of individuals suffering from medical disorders and suggest ways of fighting various health problems by modifying the individual's intake of certain food items.
Strong scientific evidence
Biotin: Biotin is an essential water-soluble B vitamin. The name biotin is taken from the Greek word bios meaning "life." Without biotin, certain enzymes, including acetyl-CoA carboxylase and pyruvate carboxylase, do not work properly, and complications can occur involving the skin, intestinal tract, and nervous system. Metabolic problems including very low blood sugars between meals, high blood ammonia, or acidic blood (acidosis) can occur. Death is theoretically possible, although no clear cases have been reported. Recent studies suggest that biotin is also necessary for processes on the genetic level in cells (DNA replication and gene expression).
Biotin deficiency is extremely rare. This is because daily biotin requirements are relatively small, biotin is found in many foods, and the body is able to recycle much of the biotin it has already used. No significant toxicity has been reported with biotin intake.
Intravenous feeding solutions (TPN) should contain biotin, in order to avoid biotin deficiency in recipient patients. This applies for patients in whom TPN is the sole source of nutrition. More study is needed in this area to make a firm recommendation.
Calcium: Calcium is the most abundant mineral in the human body and has several important functions. More than 99% of total body calcium is stored in the bones and teeth where it supports the structure. The remaining 1% is found throughout the body in blood, muscle, and the intracellular fluid. Calcium is needed for muscle contraction, blood vessel constriction and relaxation, the secretion of hormones and enzymes, and nervous system signaling. A constant level of calcium is maintained in body fluid and tissues so that these vital body processes function efficiently.
The body gets the calcium it needs in two ways. One method is dietary intake of calcium-rich foods, including dairy products, which have the highest concentration per serving of highly absorbable calcium, and dark, leafy greens or dried beans, which have varying amounts of absorbable calcium. Calcium is an essential nutrient required in substantial amounts, but many diets are deficient in calcium.
The other way the body obtains calcium is by extracting it from bones. This happens when blood levels of calcium drop too low and dietary calcium is not sufficient. Ideally, the calcium that is taken from the bones will be replaced when calcium levels are replenished. However, simply eating more calcium-rich foods does not necessarily replace lost bone calcium, which leads to weakened bone structure.
Hypocalcaemia is defined as a low level of calcium in the blood. Symptoms of this condition include sensations of tingling, numbness, and muscle twitches. In severe cases, tetany (muscle spasms) may occur. Hypocalcaemia is more likely to be due to a hormonal imbalance, which regulates calcium levels, rather than a dietary deficiency. Excess calcium in the blood can cause nausea, vomiting, and calcium deposition in the heart and kidneys. This usually results from excessive doses of vitamin D and can be fatal in infants.
Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, and fruits, as well as shellfish, avocado, and beef (organs such as liver). Because copper is found in the earth's crust, most of the world's surface water and ground water used for drinking purposes contains small amounts of copper.
Copper is involved in numerous biochemical reactions in human cells. Copper is a component of multiple enzymes, is involved with the regulation of gene expression, mitochondrial function/cellular metabolism, connective tissue formation, as well as the absorption, storage, and metabolism of iron. Copper levels are tightly regulated in the body.
Copper deficiency can occur in infants fed only cow-milk formulas (which are relatively low in copper content), premature/low-birth weight infants, infants with prolonged diarrhea or malnutrition, individuals with malabsorption syndromes (including celiac disease, sprue, or short bowel syndrome), cystic fibrosis, in the elderly, or those receiving intravenous total parenteral nutrition (TPN) or other restrictive diets.
Folic acid: Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food and folic acid is the synthetic form of this vitamin. Folic acid is well-tolerated in amounts found in fortified foods and supplements. Sources include cereals, baked goods, leafy vegetables (spinach, broccoli, lettuce), okra, asparagus, fruits (bananas, melons, lemons), legumes, yeast, mushrooms, organ meat (beef liver, kidney), orange juice, and tomato juice. Folic acid is frequently used in combination with other B vitamins in vitamin B complex formulations.
Folate deficiency will occur if the body does not get the adequate amount of folic acid from dietary intake. Folic acid has been shown to be effective in the treatment of anemia due to folate deficiency.
Studies have proven that folate consumption during pregnancy prevents deficiency and anemia in pregnant women. Low folate levels during pregnancy may contribute to birth defects and pregnancy loss.
Consuming a high dietary intake of folate and taking folic acid supplements orally during pregnancy reduces the risk of neural tube birth defects in the infant.
Folate deficiency has been observed in alcoholics. Alcohol interferes with the absorption of folate and increases excretion of folate by the kidney. Many alcohol abusers have poor quality diets that do not provide the recommended intake of folate. Increasing folate intake through diet, or folic acid intake through fortified foods or supplements, may be beneficial to the health of alcoholics.
Iodine: Iodine is an element (atomic number 53), which is required by humans for the synthesis of thyroid hormones (triiodothyronine/T3 and thyroxine/T4).
Iodine is found in the diet, so deficiencies are caused by dietary insufficiencies. Chronic iodine deficiency can lead to numerous health problems in children and adults, including thyroid gland dysfunction (including goiter) and various neurologic, gastrointestinal, and skin abnormalities. Iodine deficiency in pregnant or nursing mothers can lead to significant neurocognitive deficits in their infants. "Cretinism" or severe mental retardation is a rare outcome of severe iodine deficiency during early development. Growth stunting, apathy, impaired movement, or speech/hearing problems may occur. Many individuals living in developing countries may be at risk of iodine deficiency and its complications, and iodine deficiency is considered to be a preventable cause of mental retardation.
Iodine deficiency is rare in industrialized countries such as the United States, due to enrichment of table salt and cattle feed with iodine. But deficiency is common in developing countries, where supplementation may be considered.
Iron: Iron is an essential mineral and an important component of proteins involved in oxygen transport and metabolism. Iron is also an essential cofactor in the synthesis of neurotransmitters such as dopamine, norepinephrine, and serotonin. About 15 percent of the body's iron is stored for future needs and mobilized when dietary intake is inadequate. The body usually maintains normal iron status by controlling the amount of iron absorbed from food.
There are two forms of dietary iron: heme and non-heme. Sources of heme iron include meat, fish, and poultry. Sources of non-heme iron, which is not absorbed as well as heme iron, include beans, lentils, flours, cereals, and grain products. Other sources of iron include dried fruit, peas, asparagus, leafy greens, strawberries, and nuts.
Iron deficiency is the most common and widespread nutritional disorder in the world. The World Health Organization (WHO) estimates that approximately two billion people - over 30% of the world's population - are anemic. Anemia is a low level of healthy red blood cells (RBCs) in the body. RBCs carry oxygen to the tissues, and low levels of oxygen place stress on the body.
L-carnitine: The main function of L-carnitine is to transfer long-chain fatty acids in the form of their acyl-carnitine esters across the inner mitochondrial membrane before beta-oxidation. In humans, it is synthesized in the liver, kidney, and brain and actively transported to other areas of the body. For example, 98% of the total body L-carnitine is confined to the skeletal and cardiac muscle at concentrations approximately 70 times higher than in the blood serum.
Supplementation may be necessary in rare cases of primary carnitine deficiency, which may be caused by a defect in carnitine biosynthesis, a defect in carnitine active transport into tissue, or a defect in renal (kidney) conservation of carnitine. Known conditions of secondary deficiency of carnitine (insufficiency), in which L-carnitine is effective, include chronic stable angina and intermittent claudication characterized by distinct tissue hypoxia (low oxygen levels). Another condition that may benefit from carnitine supplementation is decreased sperm motility.
Although use in preterm infants suggests carnitine supplementation may aid in maintaining or increasing plasma carnitine levels and possibly weight gain, carnitine is not routinely added to preterm total parenteral nutrition (TPN). However, soy-based infant formulas are fortified with carnitine to levels found in breast milk.
Carnitine supplementation, both intravenous (injection) and oral (by mouth), is indicated for cases of primary and secondary carnitine deficiency. Use of L-carnitine in primary carnitine deficiency restores plasma carnitine levels to nearly normal levels. Muscle carnitine levels may rise only slightly; however, muscle function can be normalized.
Currently, there is insufficient evidence to support the use of carnitine in the total parenteral nutrition for adults, full-term infants, or pre-term infants. Additional study is needed in this area.
Niacin: Vitamin B3 is made up of niacin (nicotinic acid) and its amide, niacinamide, and can be found in many foods, including yeast, meat, fish, milk, eggs, green vegetables, and cereal grains. Dietary tryptophan is also converted to niacin in the body. Vitamin B3 is often found in combination with other B vitamins including thiamine, riboflavin, pantothenic acid, pyridoxine, cyanocobalamin, and folic acid.
Niacin (vitamin B3) and niacinamide are approved by the U.S. Food and Drug Administration (FDA) for the treatment of niacin deficiency. Pellagra is a nutritional disease that develops due to insufficient dietary amounts of vitamin B3 or the chemical it is made from, tryptophan. Symptoms of pellagra include skin disease, diarrhea, dementia, and depression.
Pantothenic acid: Pantothenic acid (vitamin B5) is essential to all life and is a component of coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol.
Pantothenic acid deficiency has been very rarely observed in humans, except in severe malnutrition. In cases of true pantothenic acid deficiency, oral pantothenic acid therapy is accepted as a treatment. It may also be merited as prevention in select patients at high risk for malnutrition. It should be included in tube feeds or parenteral (intravenous) nutrition formulas for patients unable to eat on their own.
Phosphorus: Phosphorus is a mineral found in many foods, such as milk, cheese, dried beans, peas, colas, nuts, and peanut butter. Phosphate is the most common form of phosphorus. In the body, phosphate is the most abundant intracellular anion. It is critical for energy storage and metabolism, for the utilization of many B-complex vitamins, to buffer body fluids, for kidney excretion of hydrogen ions, for proper muscle and nerve function, and for maintaining calcium balance. Phosphorus is vital to the formation of bones and teeth, and healthy bones and soft tissues require calcium and phosphorus to grow and develop throughout life. Inadequate intake of dietary phosphate can lead to hypophosphatemia (low levels of phosphate in the blood), which can lead to long-term potentially serious complications. Conversely, excess phosphate intake can lead to hyperphosphatemia (high blood phosphorus levels), which can occur particularly in people with impaired kidney function, and can lead to potentially serious electrolyte imbalances, adverse effects, or death.
Phosphates are used clinically to treat hypophosphatemia, hypercalcemia (high blood calcium levels), as saline laxatives, and in the management of calcium-based kidney stones. They may also be of some benefit to patients with vitamin D resistant rickets, multiple sclerosis, and diabetic ketoacidosis.
Critically ill patients receiving intravenous feedings often have low phosphate levels. Phosphate levels should be closely monitored in such patients, particularly if kidney function is impaired. Addition of phosphate to TPN solutions should be under the supervision of a licensed nutritionist.
Pyridoxine: Vitamin B6 (pyridoxine) is required for the synthesis of the neurotransmitters serotonin and norepinephrine as well as for myelin formation. Pyridoxine deficiency in adults principally affects the peripheral nerves, skin, mucous membranes, and the blood cell system. In children, the central nervous system (CNS) is also affected. Deficiency can occur in people with uremia, alcoholism, cirrhosis, hyperthyroidism, malabsorption syndromes, congestive heart failure (CHF), and in those taking certain medications. Mild deficiency of vitamin B6 is common. Major sources of vitamin B6 include: cereal grains, legumes, vegetables (carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour.
Pyridoxine supplements are effective for preventing and treating pyridoxine deficiency and neuritis due to inadequate dietary intake, certain disease states, or deficiency induced by drugs such as isoniazid (INH) or penicillamine. Dietary supplements should be taken under the guidance of a qualified healthcare provider.
Cycloserine is a prescription antibiotic that may cause anemia, peripheral neuritis, or seizures by acting as a pyridoxine antagonist or increasing excretion of pyridoxine. Requirements for pyridoxine may be increased in patients receiving cycloserine. Pyridoxine may be recommended by a healthcare provider to prevent these adverse effects.
Pyridoxine-dependent seizures in newborns can result from use of high-dose pyridoxine in pregnant mothers or from genetic (autosomal recessive) pyridoxine dependency. Refractory seizures in newborns that are caused by pyridoxine dependence may be controlled quickly with intravenous administration of pyridoxine by a qualified healthcare provider.
The need for vitamin B6 supplementation in women taking birth control pills has not been proven although some studies show decreased pyridoxine levels in these women. Supplementation of B6 should be approached cautiously since the long-term effects of such therapy are uncertain.
Riboflavin: Riboflavin (Vitamin B2) is a water-soluble vitamin that is involved in vital metabolic processes in the body and is necessary for normal cell function, growth, and energy production. Small amounts of riboflavin are present in most animal and plant tissues.
Healthy individuals who eat a balanced diet rarely need riboflavin supplements. Good dietary sources of riboflavin are milk (and other dairy products), eggs, enriched cereals/grains, meats, liver, and green vegetables (such as asparagus or broccoli). Intake may be lower in vegetarians compared to non-vegetarians.
Studies suggest that riboflavin is beneficial in patients with riboflavin deficiency (ariboflavinosis). Ariboflavinosis may cause weakness, throat swelling/soreness, glossitis (tongue swelling), angular stomatitis/cheilosis (skin cracking or sores at the corners of the mouth), dermatitis (skin irritation), or anemia.
Particular groups may be particularly susceptible to riboflavin deficiency, including the elderly, those with chronic illnesses, the poor, and those with alcohol dependency. Patients with suspected riboflavin deficiency should be evaluated by a qualified healthcare professional.
Thiamin: Thiamin (also spelled "thiamine") is a water-soluble B-complex vitamin, previously known as vitamin B1 or aneurine. Thiamin was isolated and characterized in the 1920s, and thus was one of the first organic compounds to be recognized as a vitamin.
Thiamin is involved in numerous body functions, including: nervous system and muscle functioning; flow of electrolytes in and out of nerve and muscle cells (through ion channels); multiple enzyme processes (via the coenzyme thiamin pyrophosphate); carbohydrate metabolism; and production of hydrochloric acid (which is necessary for proper digestion). Because there is very little thiamin stored in the body, depletion can occur as quickly as within 14 days.
Severe chronic thiamin deficiency (beriberi) can result in potentially serious complications involving the nervous system/brain, muscles, heart, and gastrointestinal system.
Dietary sources of thiamin include beef, Brewer's yeast, legumes (beans, lentils), milk, nuts, oats, oranges, pork, rice, seeds, wheat, whole grain cereals, and yeast. In industrialized countries, foods made with white rice or white flour are often fortified with thiamin (because most of the naturally occurring thiamin is lost during the refinement process).
While typically asymptomatic, the elderly have been found to have lower thiamin concentrations than younger people. There is limited evidence that thiamin supplementation may be beneficial in individuals with persistently low thiamin blood levels. Further study is necessary before a firm conclusion can be formed in this area.
Vitamin A: Vitamin A is a fat-soluble vitamin that is derived from two sources: preformed retinoids and provitamin carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources like liver, kidney, eggs, and dairy produce. Carotenoids like beta-carotene (which has the highest vitamin A activity) are found in plants such as dark or yellow vegetables and carrots.
Natural retinoids are present in all living organisms, either as preformed vitamin A or as carotenoids, and are required for a vast number of biological processes like vision and cellular growth. A major biologic function of vitamin A (as the metabolite retinal) is in the visual cycle. Research also suggests that vitamin A may reduce the mortality rate from measles, prevent some types of cancer, aid in growth and development, and improve immune function.
Recommended daily allowance (RDA) levels for vitamin A oral intake have been established by the U.S. Institute for Medicine of the National Academy of Sciences to prevent deficiencies in vitamin A. At recommended doses, vitamin A is generally considered non-toxic. Excess dosing may lead to acute or chronic toxicity.
Vitamin A deficiency is rare in industrialized nations but remains a concern in developing countries, particularly in areas where malnutrition is common. Causes of vitamin A deficiency include malnutrition and liver disease. Prolonged deficiency can lead to xerophthalmia (dry eye) and ultimately to night blindness or total blindness, as well as to skin disorders, infections (such as measles), diarrhea, and respiratory disorders.
Vitamin B12: Vitamin B12 is an essential water soluble vitamin that is commonly found in a variety of foods such as fish, shellfish, meats, and dairy products. Vitamin B12 is frequently used in combination with other B vitamins in a vitamin B complex formulation. It helps maintain healthy nerve cells and red blood cells, and it is also needed to make DNA, the genetic material in all cells. Vitamin B12 is bound to the protein in food. Hydrochloric acid in the stomach releases B12 from protein during digestion. Once released, B12 combines with a substance called intrinsic factor (IF) before it is absorbed into the bloodstream.
The human body stores several years' worth of vitamin B12, so nutritional deficiency of this vitamin is extremely rare. The elderly are the most at risk due to a decrease in absorption of vitamin B12. Deficiency can result from being unable to use vitamin B12; this can be caused by a disease known as pernicious anemia. Additionally, strict vegetarians or vegans who are not taking in proper amounts of B12 are also prone to a deficiency state.
Vitamin B12 deficiency is a cause of megaloblastic anemia. In this type of anemia, red blood cells are larger than normal and the ratio of nucleus size to cell cytoplasm is increased. There are other potential causes of megaloblastic anemia, including folate deficiency or various inborn metabolic disorders. If the cause is B12 deficiency, then treatment with B12 is the standard approach. Patients with anemia should be evaluated by a physician in order to diagnose and address the underlying cause.
Studies have shown that a deficiency of vitamin B12 can lead to abnormal neurologic and psychiatric symptoms. These symptoms may include: ataxia (shaky movements and unsteady gait), muscle weakness, spasticity, incontinence, hypotension, vision problems, dementia, psychoses, and mood disturbances. Researchers report that these symptoms may occur when vitamin B12 levels are just slightly lower than normal and are considerably above the levels normally associated with anemia. People at risk for vitamin B12 deficiency include strict vegetarians, elderly people, and people with increased vitamin B12 requirements associated with pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, liver or kidney disease.
Administering vitamin B12 orally, intramuscularly, or intranasally is effective for preventing and treating dietary vitamin B12 deficiency.
Vitamin C: Vitamin C (ascorbic acid) is a water-soluble vitamin, which is necessary in the body to form collagen in bones, cartilage, muscle, and blood vessels, and aids in the absorption of iron. Dietary sources of vitamin C include fruits and vegetables, particularly citrus fruits such as oranges.
Severe deficiency of vitamin C causes scurvy. Although rare, scurvy includes potentially severe consequences including sudden death. Scurvy is treated with vitamin C and should be monitored by a qualified healthcare professional.
Based on scientific research, vitamin C appears to improve oral absorption of iron. Concurrent vitamin C may aid in the absorption of iron dietary supplements.
Vitamin D: Vitamin D is found in numerous dietary sources such as fish, eggs, fortified milk, and cod liver oil. The sun is also a significant contributor to the daily production of vitamin D, and as little as 10 minutes of exposure is thought to be enough to prevent deficiencies. The term "vitamin D" refers to several different forms of this vitamin. Two forms are important in humans: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D2 is synthesized by plants. Vitamin D3 is synthesized by humans in the skin when it is exposed to ultraviolet-B (UVB) rays from sunlight or the diet.
The major biologic function of vitamin D is to maintain normal blood levels of calcium and phosphorus. Vitamin D aids in the absorption of calcium, helping to form and maintain strong bones. Recently, research also suggests vitamin D may provide protection from osteoporosis, hypertension, cancer, and several autoimmune diseases.
Rickets and osteomalacia are classic vitamin D deficiency diseases. In children, vitamin D deficiency causes rickets, which results in skeletal deformities. In adults, vitamin D deficiency can lead to osteomalacia, which results in muscular weakness in addition to weak bones. People who are at a high risk for vitamin D deficiencies are the elderly, dark skinned, obese, exclusively breastfed infants, and those who cover all exposed skin or use sunscreen whenever outside. Also, those who have fat malabsorption syndromes (e.g., cystic fibrosis) or inflammatory bowel disease (e.g., Crohn's disease) are at risk.
Familial hypophosphatemia is a rare inherited disorder characterized by impaired transport of phosphate and diminished vitamin D metabolism in the kidneys. Familial hypophosphatemia is a form of rickets. Taking calcitriol or dihydrotachysterol orally in conjunction with phosphate supplements is effective for treating bone disorders in people with familial hypophosphatemia. Management should be under medical supervision.
Vitamin E: Vitamin E is a fat-soluble vitamin with antioxidant properties. Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma, and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Dosing and daily allowance recommendations for vitamin E are often provided in Alpha-Tocopherol Equivalents (ATE) to account for the different biological activities of the various forms of vitamin E or in International Units (IU), which food and supplement labels may use. Vitamin E supplements are available in natural or synthetic forms. The natural forms are usually labeled with the letter "d" (for example, d-gamma-tocopherol), whereas synthetic forms are labeled "dl" (for example, dl-alpha-tocopherol).
Vitamin E deficiency is rare and may occur in people with diminished fat absorption through the gut (due to surgery, Crohn's disease, or cystic fibrosis), malnutrition, very low-fat diets, several specific genetic conditions (abetalipoproteinemia, "Ataxia and Vitamin E deficiency" [AVED]), very low birth weight premature infants, or infants taking unfortified formulas. Vitamin E supplementation is accepted as an effective therapy for vitamin E deficiency to halt progression of complications. Diagnosis of this condition and management should be under the care of a physician and nutritionist.
Vitamin K: The name "vitamin K" refers to a group of chemically similar fat-soluble compounds called naphthoquinones. Vitamin K1 (phytonadione) is the natural form of vitamin K, which is found in plants, and provides the primary source of vitamin K to humans through dietary consumption. Vitamin K2 compounds (menaquinones) are made by bacteria in the human gut and provide a smaller amount of the human vitamin K requirement. Vitamin K1 is commercially manufactured for medicinal use under several brand names (Phylloquinone®, Phytonadione®, AquaMEPHYTON®, Mephyton®, Konakion®). A water-soluble preparation is available for adults only as vitamin K3 (menadione).
Vitamin K is found in green leafy vegetables like spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Cooking does not remove significant amounts of vitamin K from these foods. People who eat a balanced diet including these foods are likely ingesting enough vitamin K and do not require supplementation.
Vitamin K is necessary for normal clotting of blood in humans. Specifically, vitamin K is required for the liver to make factors that are necessary for blood to properly clot (coagulate), including factor II (prothrombin), factor VII (proconvertin), factor IX (thromboplastin component), and factor X (Stuart factor). Other clotting factors that depend on vitamin K are protein C, protein S, and protein Z. Deficiency of vitamin K or disturbances of liver function (for example, severe liver failure) may lead to deficiencies of clotting factors and excess bleeding.
Vitamin K deficiency is rare, but can lead to defective blood clotting and increased bleeding. People at risk for developing vitamin K deficiency include those with chronic malnutrition (including those with alcohol dependency) or conditions that limit absorption of dietary vitamins such as biliary obstruction, celiac disease or sprue, ulcerative colitis, regional enteritis, cystic fibrosis, short bowel syndrome, or intestinal resection (particularly of the terminal ileum, where fat-soluble vitamins are absorbed). In addition, some drugs may reduce vitamin K levels by altering liver function or by killing intestinal flora (normal intestinal bacteria) that make vitamin K (for example, antibiotics, salicylates, anti-seizure medications, and some sulfa drugs). Vitamin K is routinely given to newborn infants to prevent bleeding problems related to birth trauma or when surgery is planned.
Good scientific evidence
Choline: Choline is an essential nutrient related to the water-soluble B-complex vitamins, folate, pyridoxine, and B12, and to the essential amino acid, methionine. It is synthesized in the body as well as consumed in the diet. The largest dietary source of choline is egg yolk. Choline can also be found in high amounts in liver, peanuts, fish, milk, brewer's yeast, wheat germ, soy beans, bottle gourd fruit, fenugreek leaves, shepherd's purse herb, Brazil nuts, dandelion flowers, poppy seeds, mung and other beans, and a variety of meats and vegetables, including cabbage and cauliflower.
Choline is a major building block of lecithin. Choline is a precursor to acetylcholine, a chemical used to transfer nerve impulses. Therefore, choline is believed to have neurological effects.
Choline is a constituent of phosphatidylcholine (PC), which is a component of cell walls and membranes. It is involved in fat and cholesterol metabolism and transport. In this form, choline aids in fat metabolism and transport away from the liver.
Choline is likely effective when used orally as a supplement in infant formulas. Also, choline is likely effective when used intravenously to treat parenteral nutrition-associated hepatic dysfunction.
Safflower oil: Two parts of the safflower (Carthamus tinctoria) are primarily used: the flower itself and safflower seeds. There are two types of safflower oil with corresponding types of safflower varieties: those high in monounsaturated fatty acid (oleic) and those high in polyunsaturated fatty acid (linoleic). Currently, the seed varieties that produce oil high in oleic acid and very low in saturated fatty acids predominate in the United States market. High oleic safflower oil is lower in saturates and higher in monounsaturates than olive oil. In the U.S. diet, safflower oil has been frequently substituted for oils with higher saturated fat content, as monounsaturated fat may have a beneficial effect on the risk of coronary heart disease.
Taurine: Taurine, or 2-aminoethanesulfonic acid, was originally discovered in ox (Bos taurus) bile and was named after taurus, or bull. A nonessential amino acid-like compound, taurine, is found in high abundance in the tissues of many animals, especially sea animals, and in much lower concentrations in plants, fungi, and some bacteria. As an amine, taurine is important in several metabolic processes of the body, including stabilizing cell membranes in electrically active tissues, such as the brain and heart. It also has functions in the gallbladder, eyes, and blood vessels, and it may have some antioxidant and detoxifying properties.
Early evidence suggests that taurine supplementation may aid in auditory maturation, fatty acid absorption, and increased serum taurine levels. However, additional study is needed in this area.
Unclear or conflicting scientific evidence
Black currant: The black currant (Ribes nigrum) shrub is native to Europe and parts of Asia and is particularly popular in Eastern Europe and Russia.
With a vitamin C content estimated to be five times that of oranges (2,000 milligrams/kilogram), black currant has potential dietary benefits. Black currant is also rich in rutin and other flavonoids, which are known antioxidants. Because of black currant's high essential fatty acid content, researchers believe that it may be effective in the treatment of inflammatory conditions and pain management, as well as in regulating the circulatory system and increasing immunity. There is currently a lack of information in humans on the effectiveness of black currant seed oil as nutritional supplementation.
Bromelain: Bromelain is an enzyme with the ability to digest proteins. However, there is little reliable scientific research on whether bromelain is helpful as a digestive aid. Better study is needed before a firm conclusion can be made.
Carotenoids, beta-carotene: The name "carotene" was first coined in the early 19th Century by the scientist Wachenroder after he crystallized this compound from carrot roots. Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oil, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Alpha, beta, and gamma carotene are considered provitamins because they can be converted to active vitamin A.
The carotenes possess antioxidant properties. Vitamin A serves several biological functions including involvement in the synthesis of certain glycoproteins. Vitamin A deficiency leads to abnormal bone development, disorders of the reproductive system, xerophthalmia (a drying condition of the cornea of the eye), and ultimately, death.
Although consumption of provitamin A carotenoids (alpha-carotene, beta-carotene, and beta-cryptoxanthin) can prevent vitamin A deficiency, no overt deficiency symptoms have been identified in people consuming low-carotenoid diets if they consume adequate vitamin A. After reviewing the published scientific research, the Food and Nutrition Board of the Institute of Medicine (IOM) concluded that the existing evidence in 2000 was insufficient to establish a recommended dietary allowance (RDA) or adequate intake (AI) for carotenoids.
Carrot: Carrot (Daucus carota) is a well-known root vegetable. The thick tap root's color can range from white to orange to red or purple. This change in color represents the nutrients in the carrot because some pigments, such as beta-carotene and lycopene, are also nutrients used as antioxidants. Carrot jam may improve growth in young children with vitamin A deficiency. Although the results seem promising, more research is needed.
Cranberry: Preliminary research suggests that cranberry (Vaccinium macrocarpon) juice may increase vitamin B12 absorption in patients taking drugs that reduce stomach acid, such as proton pump inhibitors like lansoprazole (Prevacid®). However, this effect may be due to the acidity of the juice rather than an active component of cranberry itself. Further study is needed before a recommendation can be made.
Devil's claw: Traditionally, devil's claw (Harpagophytum procumbens) was commonly used as an appetite stimulant and this remains a popular use. However, there is no reliable scientific evidence in this area.
Hydrazine: Cachexia is defined as physical wasting with loss of weight and muscle mass caused by disease. Patients with advanced cancer, AIDS, and some other major chronic progressive diseases may appear cachectic. Lack of appetite and cachexia often occur together. Cachexia can occur in people who are eating enough, but who cannot absorb the nutrients. Cachexia is not the same as starvation. A healthy person's body can adjust to starvation by slowing down its use of nutrients, but in cachectic patients, the body does not make this adjustment.
Hydrazine is an industrial chemical marketed as having the potential to repress weight loss and cachexia associated with cancer and to improve general appetite status. However, in large randomized controlled trials, hydrazine has not been proven effective for improving appetite, reducing weight loss, or improving survival in adults with small cell lung cancer (when used as adjuvant therapy) or metastatic colorectal cancer (when used alone).
Hydrazine has not been well evaluated for safety or toxicity during pregnancy, lactation, or childhood.
Pet therapy: Animal companionship has been used as an informal source of comfort and relief of suffering across cultures throughout history.
There is evidence from one well-designed study that animal-assisted therapy in the form of a fish aquarium in an institutional care facility for people with Alzheimer's disease may improve nutritional intake, improve weight gain, and reduce the need for nutritional supplementation.
Saccharomyces boulardii: Saccharomyces boulardii is a non-pathogenic yeast strain that has been used for the treatment and prevention of diarrhea. Saccharomyces boulardii is classified as a "probiotic," or a microorganism that when ingested, may have a positive influence on the host's health. Probiotics may exert their effects on the gastrointestinal system directly or may modulate the immune system in a larger scope.
Human studies indicate Saccharomyces boulardii may prevent antibiotic-associated diarrhea, Clostridium difficile diarrhea in combination with antibiotic therapy, diarrhea associated with tube feeds, and acute childhood diarrhea. Promising initial studies have shown that Saccharomyces boulardii may be beneficial in treating diarrhea associated with HIV. One clinical trial exists investigating the addition of Saccharomyces boulardii to nutritional support for premature infants. No evidence was found for lipid gut absorption or increased weight gain. A benefit was noted on gut flora. Additional study is needed.
Zinc: Zinc is necessary for the functioning of over 300 different enzymes and plays a vital role in an enormous number of biological processes. Zinc is necessary for the function of the antioxidant enzyme superoxide dismutase (SOD) and is in a number of enzymatic reactions involved in carbohydrate and protein metabolism.
Short-term zinc supplementation may increase weight gain and decrease infections, swelling, diarrhea, loss of appetite, and skin ulcers in children with extreme malnourishment.
Fair negative scientific evidence
Omega-3 fatty acids: Dietary sources of omega-3 fatty acids include fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), while some nuts (English walnuts) and vegetable oils (canola, soybean, flaxseed/linseed, olive) contain alpha-linolenic acid (ALA). There is evidence from multiple studies supporting the intake of recommended amounts of DHA and EPA in the form of dietary fish or fish oil supplements lowers triglycerides, reduces the risk of death, heart attack, dangerous abnormal heart rhythms, and strokes in people with known cardiovascular disease, slows the buildup of atherosclerotic plaques ("hardening of the arteries"), and lowers blood pressure slightly. However, high doses may have harmful effects, such as an increased risk of bleeding. Although similar benefits are proposed for alpha-linolenic acid, scientific evidence is less compelling and beneficial effects may be less pronounced.
There is preliminary evidence that fish oil supplementation does not improve appetite or prevent weight loss in cancer patients. Further study is warranted.
Spirulina: The term spirulina refers to a large number of cyanobacteria or blue-green algae. Both Spirulina spp. and non-Spirulinaspp. fall into the classification of cyanobacteria and include: Aphanizomenon spp., Microcystis spp., Nostoc spp., and Spirulina spp. Most commercial products contain Aphanizomenon flos-aquae, Sprirulina maxima,and/or Spirulina platensis. These algae are found in the warm, alkaline waters of the world, especially of Mexico and Central Africa. Spirulina spp.are most often grown under controlled conditions and are subject to less contamination than the non-spirulina species that are harvested naturally.
Spirulina is a rich source of nutrients, containing up to 70% protein, B-complex vitamins, phycocyanin, chlorophyll, beta-carotene, vitamin E, and numerous minerals. In fact, spirulina contains more beta-carotene than carrots. Spirulina has been used since ancient times as a source of nutrients and has been said to possess a variety of medical uses, including as an antioxidant, antiviral, antineoplastic, weight loss aid, and lipid-lowering agent. Preliminary data from animal studies demonstrate effectiveness for some conditions as well as safety, although human evidence is lacking. Based on available research, no recommendation can be made either for or against the use of spirulina for any indication.
Traditional or theoretical uses lacking sufficient evidence
Integrative therapies used in nutritional deficiencies that have historical or theoretical uses but lack sufficient clinical evidence include: acerola (Malpighia glabra, Malpighia punicifolia), agave (Agave americana), alfalfa (Medicago sativa), apple cider vinegar, applied kinesiology, arginine (L-arginine), barley (Hordeum vulgare), bee pollen, caprylic acid, carob (Ceratonia siliqua), chlorella, dandelion (Taraxacum officinale), Fenugreek (Trigonella foenum-graecum), liver extract, noni (Morinda citrifolia), raspberry (Rubus idaeus), rose hip (Rosa spp.), sea buckthorn (Hippophae rhamnoides), seaweed, kelp, bladderwrack (Fucus vesiculosus), and watercress (Nasturtium officinale).
Healthcare professionals recommendconsuming a variety of nutrient-dense foods (such as fresh vegetables and fruits) and beverages within the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol.
Consume a sufficient amount of fruits and vegetables daily. Two cups of fruit and two and one-half cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level.
Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.
Consume three or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.
Consume three cups per day of fat-free or low-fat milk or equivalent milk products.
Consume less than 10% of calories from saturated fatty acids and less than 300 milligrams daily of cholesterol, and keep trans fatty acid consumption as low as possible. Trans fatty acid consumption is linked to the development of cardiovascular diseases.
Keep total fat intake between 20 - 35% of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.
Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils.
Choose fiber-rich fruits, vegetables, and whole grains often.
Choose and prepare foods and beverages with few added sugars or caloric sweeteners. High refined sugars are linked to the development of blood sugar regulatory problems, such as type 2 diabetes and insulin resistance.
Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.
Consume less than 2,300 milligrams (approximately one teaspoon of salt) of sodium per day. Inreased intake of sodium may be linked to the development of high blood pressure.
Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.
Those who choose to drink alcoholic beverages should do so sensibly and in moderation. Moderation is defined as the consumption of up to one drink per day for women and up to two drinks per day for men.
Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions.
Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.
Taking a multi-vitamin supplement daily in addition to a healthy diet is recommended. A multi-vitamin will contain the dietary reference intake (DRI) of vitamins and minerals recommended by healthcare providers.