Nutrient deficiency hiding in plain sight

You may think a vitamin deficiency will manifest itself with subtle signs, like fatigue or brittle fingernails. But sometimes, common deficiencies cause big problems.

And doctors miss them because they’re so busy looking for a disease, instead of a nutritional deficiency. This happens more often than you would think.

Here’s one reason why…

The government’s Recommended Daily Allowances (RDAs) for vitamins and nutrients are woefully inadequate. They’re not set at levels that help you achieve optimal health. They’re set at levels to keep you from developing a frank nutritional deficiency.

So, for example, the RDA for vitamin C isn’t enough for you to achieve optimal health. It’s just enough to keep you from developing scurvy.

That’s why, if you try to follow the government’s advice about nutrition, you’ll come up short every time.

No wonder Americans are still getting sick. Most of us only get enough nutrients–if we’re careful–to keep us safe from the diseases of under-nutrition that plagued 19th-century populations.

But even if you are healthy enough to avoid scurvy, you can still develop serious nutritional deficiencies. And they can cause big problems. As I said earlier, very often the symptoms hit you like a ton of bricks. But doctors can still miss the mark because they can’t fathom that a simple vitamin deficiency can cause so much trouble…or even exist in our modern society…but it can!

For example, here’s the story of a patient I heard about through a colleague. I’ll call him Bill for the sake of my story.

Bill was 56 years old. And one night, as he was watching TV, Bill began to feel nauseated, sweaty, and out of breath. His heart was racing.

Then suddenly, Bill’s legs began to shake and jerk. And he was not just keeping time to the latest offering on MTV. Nor was it a case of sudden-onset, “restless leg” syndrome. Bill had a real medical condition. One with a real cure.

Feeling like something was terribly wrong, Bill went to the Emergency Room at his local hospital.

At the hospital, Bill told the ER doctors he had not felt well for about a year. He had been feeling dizzy, tired, and depressed. And about two weeks ago, Bill said, when he stood up at work, everything felt off balance.

But since he was 56, Bill figured it was just a sign of old age.

Indeed, the only thing doctors could find during Bill’s first hospital stay was that his blood pressure dropped when he stood up. This is known as orthostatic hypotension. After a short time, the doctors sent Bill home. With no answers. And no help.

Not surprisingly, within a few days, the problems started all over again.

Again, Bill rushed back to the hospital. This time, Bill walked with an abnormal, “flat- footed” gait. This prompted the ER doctors to go searching for problems with his central nervous system. Maybe he had multiple sclerosis. Or Parkinson’s disease.

But the MRI was normal.

Finally, someone had the good sense to examine Bill. Yes, when all else fails, some doctors do actually examine their patients.

Once they took a closer look, doctors quickly discovered that Bill had impaired sensation in his feet. He could not sense his position on the floor. This is called proprioception.

But Bill did not have diabetes or an infection. Nor did he have multiple sclerosis.

Finally, after considering everything else, the doctors discovered that Bill had a simple vitamin B 12 deficiency. But it took two trips to the hospital to figure that out.

You may wonder, how can someone have such a severe B vitamin deficiency? Can nutritional deficiencies really cause neurological changes?

You bet they can. And it actually happens quite often.

Vitamin B 12   is important for every cell in the body. Deficiencies can first show up in sensitive nerve cells. And in red blood cells–which are short-lived. This causes anemia, formerly known as “pernicious anemia.”

You find vitamin B12  in eggs, meat and milk. Basically, you get it from all the things you’ve been told to avoid eating.

But the process of absorbing vitamin B12 from the diet is complex. The stomach must first make a substance called intrinsic factor (IF). This binds to the B12 so that it can be absorbed lower down in the intestine.

GI surgery, certain medications, and infections can interfere with B12 absorption. So can IBS and other irritable bowel disorders.

Now, here’s the good news…

You can reverse B12 deficiencies just as quickly as they come on.

If you have a B12 deficiency, you should get a B12 injection. This is the best way to get your levels up quickly. Plus, it’s a good option, given the difficulty absorbing it through the GI tract. But for long-term maintenance, you can take a high-quality B12 supplement. Look for the liquid sublingual form that you place under your tongue. You’ll absorb this better than a tablet.

Bill’s case is not rare. In fact, more than 50 percent of adults in the U.S. may have low B12 levels, if they’re anything like the residents of Framingham, Mass. Ten years ago, researchers analyzed data from the well-known Framingham Offspring Study. They took blood samples from 3,000 men and women, ages 26 to 83 years.

The researchers found that 39 percent of the subjects had plasma B12 levels in the “low normal” range–below 258 picomoles per liter (pmol/L). More than 16 percent of them fell below 185 pmol/L. And nearly 9 percent of subjects had outright deficiencies–below the 148 pmol/L. This is the level the government sets as an outright deficiency. But, like Bill, you can experience neurological symptoms long before your numbers drop this far down.

Bill’s case is not rare in another way too. Like Bill, it often takes several trips to the hospital before doctors figure out what’s wrong with you.

A recent study showed that one in five patients on Medicare was readmitted to the hospital within one month of discharge. Usually because doctors never figured out what was wrong in the first place.

Given how little Medicare now pays doctors to provide care, this might not be such as surprise.

Starting last year, Medicare began penalizing hospitals for patients who were re-admitted within one month of discharge. Let’s hope you don’t die on the 29th day.


1. Am J Clin Nutr February 2000 vol. 71 no. 2 514-522