Nutrients of Concern in America
As a plant-based eater (vegan), people often ask me, “Where do you get your protein?” This always makes me smile, because I know two things:
- Studies show that most vegans, vegetarians, and omnivores consume 170% of their protein needs.[i] This means that like everyone else, I am probably getting 70% more protein that I actually need. Furthermore, protein is NOT a nutrient of concern.
- There are ten recognized shortfall nutrients, and the easiest way to ensure that one gets enough of these nutrients is by eating a diet consisting mostly of whole plant foods, keeping processed foods to a minimum.
What is a Nutrient of Concern?
When one looks at the topic of nutrients of public health concern, one has to ask, “according to whom?” One organization that looks at this matter is the US Offices of Disease Prevention and Health Promotion (ODPHP). They use nutrient intake values generated by the Food and Nutrition Board of the U.S. Institute of Medicine.[iii] Here is a link to their report.[iv]
The concept of nutrients of concern involves two groups of nutrients: overconsumed nutrients, and underconsumed (shortfall) nutrients. This article will not cover the important role of the many nutrients listed; however you can ‘click’ on each nutrient, and this will take you to the National Institutes of Health (NIH) factsheet (where available) to learn more about it.
1) Shortfall Nutrients
All but one of the shortfall nutrients are micronutrients. Micronutrients consist of about[ii] 35 essential vitamins and minerals that we must get from our diet because our body does not make them. Recommended daily allowances (RDA) have been set to ensure that we get adequate levels of all of these nutrients. The RDA that you may be familiar with is usually set a couple of standard deviations above what would be required to prevent deficiency which could cause serious illness.
Micronutrients play essential roles in our metabolism, keeping us alive. They play an important role as cofactors in critical metabolic functions such as keeping our heart pumping, our lungs breathing, or our digestion happening etc. They also play an important role in less immediate metabolic processes that involve things like fighting off infection, preventing cancer from developing, or minimizing the effects of aging. In the case of nutrient shortfall, immediate needs obviously have priority over our long-term needs. So while you might not notice any short-term consequences of deficiency of a particular nutrient, your chance of getting a disease, such as cancer could be increased due to this shortfall.
The ODPHP list of Shortfall Nutrients
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin C
- Iron – (underconsumed by adolescent & premenopausal females, and pregnant women)
2) Overconsumed Nutrients
- Saturated fat
Getting to Know the Nutrients of Concern
Vitamin A – Vitamin A provided one of the first lessons on the dangers of supplementation. An editorial in the American Journal of Epidemiology said it best- “Thirty years ago, vitamin A was all the rage, expecting that if we gave beta carotene to people, it would prevent cancer. But instead, it caused even more.”[vi] Vitamin A is an essential vitamin, but we should look at food sources, not supplements to meet our nutritional needs. Foods topping the list for vitamin A content include sweet potato, pumpkin, carrots, squash, and green leafy vegetables. Here is a list of foods containing vitamin A.
Vitamin D – Humans evolved in tropical regions. Living in these areas, we always got lots of sunshine, so our bodies evolved to manufacture vitamin D, rather than get it from food sources. This vitamin/hormone is manufactured by the body through skin exposure to UVB rays. Current statistics find 70% of Americans deficient in Vitamin D. Here in Canada we do not get enough UVB rays for at least half of the year, therefore supplementation is recommended for fall and winter months. This is one of few nutrients where population-wide supplementation is recommended because whole food sources will not meet the body’s need. This evidence-based video from Dr. Greger at nutritionfacts.org looks at the current evidence, and he recommends 2000 IU per day.
Vitamin E – The National Health and Nutrition Examination Survey (NHANES) 2003 – 2006 at the Centers for Disease Control and Prevention found that over 90% of American adults[vii] failed to meet a criterion of vitamin E adequacy based on the Estimated Average Requirement. Although this vitamin serves an important antioxidant role in the body, taking antioxidant vitamin supplements, as opposed to eating an antioxidant-rich diet, appears to lead to a shorter lifespan. According to nutritionfact.org, “the minimum “Recommended Daily Allowance” of antioxidants may be best met through intake of whole fruits and vegetables.” Some of these foods include almonds, raw seeds and green leafy vegetables (Swiss chard, mustard greens, spinach, turnip greens and kale). Here is a list of foods high in vitamin E from the Harvard School of Public Health.
Folate – Folate is a water-soluble B vitamin that is naturally present, once again, in dark green vegetables like broccoli and spinach. Dried legumes such as chickpeas, beans and lentils are good sources of folate. According to analyses of data from the 2003–2006 National Health and Nutrition Examination Survey (NHANES), most people in the United States obtain adequate amounts of folate, although some groups are still at risk of obtaining insufficient amounts. Certain groups, including women of childbearing age and non-Hispanic black women, are at risk of insufficient folate intakes.[viii] Here is the Dietitians of Canada’s list of folate food sources.
Vitamin C – Vitamin C, also known as L-ascorbic acid, is a water-soluble vitamin that is naturally present in most vegetables and fruits. It is hard to understand how people in developed countries could be deficient in vitamin C unless they are living in a food desert. This evidence-based video recommends vitamin C intake of 200 milligrams a day. Single servings of fruits and vegetables may have about 50 milligrams each; so, five servings of fruits and veggies a day should get you to ideal blood levels. If you eat the recommended eight servings per day[ix] of fruits and vegetables, you will easily meet your vitamin C requirements.
Calcium– The good news is that seventy-five percent[x] of Americans reach the daily recommended intake of calcium of 1,000mg per day for adult men and women. This means that twenty-five percent of Americans fall short on this nutrient. US government panels now recommend against calcium supplementation because users of calcium supplements tended to have increased rates of heart disease, stroke, and death. Furthermore, calcium supplementation does not appear to be effective either. So we should get calcium from our food. While dairy is touted as a good source of this nutrient, calcium is more readily absorbable from greens such as kale and broccoli than milk. Getting your calcium from plants also means that getting fiber, antioxidants, and folate as well, whereas dairy calcium comes with saturated fat, hormones, and cholesterol. Other plant-based sources include dark green leafy vegetables, tofu made with calcium sulfate, calcium-fortified soy milk and orange juice. Here is a larger list of plant-based sources of calcium.
Magnesium – “Magnesium is an essential mineral in whole grains, leafy green vegetables, legumes—meaning beans, peas, lentils and soy—and nuts [as well as seeds], that acts as a co-factor in hundreds of enzymatic reactions in the human body. A considerable body of evidence indicates that a higher intake of dietary magnesium may favorably affect a cluster of metabolic and inflammatory disorders”[xi], including many of our top killers, like diabetes and heart disease. The recommended daily intake is 400 mg. The average American gets only 293 mg.[xii] Magnesium is a crucial element required for photosynthesis in plants, so once again, whole food sources readily provide sufficient quantities of this nutrient. This evidence-based video on magnesium provides a lot of information on this important vitamin.
Iron – The recommended daily intake of iron for adult women is 18mg daily and 8mg for men. Women are more likely than men to suffer from iron deficiency. In developing countries, 50% of pregnant woman, and about 40% of preschool children are estimated to be anaemic. Iron deficiency is the most common and widespread nutritional disorder in the world. As well as affecting a large number of children and women in developing countries, it is the only nutrient deficiency which is also significantly prevalent in industrialized countries. The numbers are staggering: two billion people – over 30% of the world’s population – are anaemic.
There are two types of iron; heme iron found in animal flesh, and non-heme iron found in plants. The avoidance of heme iron may be one of the key elements of plant-based protection against metabolic syndrome, and may also be beneficial in lowering heart disease risk.[xiii] The intake of heme iron (but not non-heme iron) was associated with an increased risk of stroke[xiv], as well as type 2 diabetes[xv]. And the same for cancer, with up to 12% increased risk for every milligram of daily heme iron exposure.[xvi] In fact, you can actually tell how much meat someone is eating by doing a tumor biopsy.[xvii]
Potassium– The recommended intake of potassium for adults is 4,700mg per day, but currently only 2% percent of American adults reach this goal.[xviii] A full 98% of Americans are iron deficient. One big reason why is that sodium often takes the place of nutrients like potassium in processed foods like cheese, packaged meats, fast food, and pastries. The most concentrated source of potassium is whole plant foods. It is that simple. Eat a diet based on whole plant foods and you will get enough potassium.
Fiber– Fiber was placed last on this list, but as you will soon see, it should probably be at the top of the list. Fiber is not a micronutrient, but a macronutrient; the only one on the shortfall list. Fiber is actually a carbohydrate. Not long ago we thought fiber was just an indigestible substance that passively moved through our digestive tract. Thanks to recent research on fiber and on our gut microbiota, we now know that many important nutrients are bound to fiber, and as well, fiber is the primary food for our beneficial gut bacteria. The recommended daily intake of dietary fiber is 31 grams per day, but only three percent of Americans reach the recommended intake! The average intake is only about 15 grams a day[xix], so we get less than half the minimum. If you break it down by age and gender, the percentage of men between ages 14 and 50 getting the minimum adequate intake was zero. Semi-vegetarians make the minimum, and those eating completely plant-based diets manage to triple the average. Fiber is not found in any animal foods, so plant foods in their whole form are THE source of dietary fiber. Note that fiber is largely removed from processed food. This evidence-based video covers the importance of fiber in our diet.
Americans overconsume two nutrients: sodium and saturated fat- both of which have highly detrimental effects on our health. As well, both of these nutrients increase our risk of developing heart (cardiovascular) disease, the number one killer in America.
Sodium – Sodium, otherwise known as table salt, is an essential mineral. While some salt in our diet is good, more is not better. Salt raises blood pressure, increasing risk of heart attack and stroke. It has also been tied to stomach cancer, kidney stones, bone loss, obesity even, and direct damage to our kidneys, arteries, and heart.[xx] The science is overwhelming on the negative effects of too much sodium in our diet, and there should be not debate at this point. However… the processed food industry is a billion dollar industry that depends heavily on salt to inexpensively preserve and enhance the taste of food, and it has millions to spend on any research that could cast doubt on the science demonstrating concerns around excess sodium. As a result, we are never likely to see the end of this debate.
Ever since our ancient ancestors left the ocean to live on land, they evolved in environments of salt scarcity, so are extremely good at conserving salt. In the end, few of us need to concern ourselves with including extra salt into our diet. As you can see from the attached pie chart, 77% of the sodium we consume is buried in the prepared, processed, or restaurant food that we eat. This is why we need to be vigilant about sodium in the modern age since fewer meals are now being cooked at home.
Saturated Fat – Saturated fat is a type of fat (macronutrient) that is solid at room temperature. It is found in most animal foods, such as dairy products, eggs, and meat. It is also found in most baked goods and junk food. It can be found in very few plant foods (for example, tropical plant oils like palm and coconut oil), but for the most part, whole plant foods do not contain saturated fat. The easiest way to avoid saturated fat is to avoid animal products, baked and fried foods and junk food. If you are buying processed foods, be sure to check the Nutrition Facts label on the package and look for zero saturated or trans fat. The US Institute of Medicine has not set an upper limit on saturated fat in the diet because any amount will increase serum cholesterol. In other words, the upper limit is essentially zero.[xxi] Despite what the media reported in 2015, saturated fat should be avoided altogether. In Finland, the use of science-based dietary guidelines for reducing saturated fat intake resulted in an 80% drop in cardiac mortality across the entire country.
As you can see, there are just two overconsumed nutrients; sodium and saturated fat. What might seem curious to you is that ‘calories’ are not on this list. With so many North Americans overweight, why do we not see calories listed here. This is because calories are not actually a nutrient. Calories are yielded from the three macronutrients: fat, carbohydrates and protein.
With three out of four men in America (74 percent) and 64 percent of women overweight or obese,[v] it is obvious that Americans are consuming too many calories. Although it seem counter-intuitive, this issue of overconsumption relates directly to the matter of nutrient shortfalls because of the consumption of ‘empty calories’ in the North American diet.
Much of America’s overconsumption of calories comes in the form of refined, processed macronutrients; particularly refined fats and carbohydrates. The pie chart below that aggregates data from the US Department of Agriculture shows the American dietary trends over three decades.
If you click on it you can see that calorie consumption went up by a whopping 25% in these thirty years! You can also see how few calories are derived from fruits and vegetables. There is a lot of other information to be gleaned from this chart. For example, the added fats and oils are highly processed foods containing very few micronutrients. The added sugars contain no micronutrients, and most of the flour and cereal products are highly refined. As a result, you can see that over 50% of our diet is either devoid of, or sadly lacking in micronutrients.
Avoiding Nutrient Shortfall
At first glance one might think that we would have to eat more food to avoid the nutrient shortfalls listed above, but this is not the case. With diet, like everything, it is about quality, not quantity.
So, how is it that North Americans could possibly be undernourished while simultaneously being overweight? The answer lies in our (over)consumption of refined, processed food that has been stripped of many of its nutrients. If you are going to try to fix this problem, dessert is perhaps the best place to start when trying to remove calories of poor nutritional value. Unless your idea of dessert is fresh fruit, then you are likely consuming a large number of calories of low nutrient density, thereby missing out on the opportunity to obtain many of the important micronutrients.
The next place to look for dietary improvement is to examine anything that comes from a package, can, or a box. This is not to say that these are not healthy foods, but you do have to take the time to look at the Nutrition Facts label to determine the nutritional content of these foods or food products. More disconcerting is that some of the nutrients of concern listed here are not included on the Nutrition Facts label.
When it comes to nutrition, there is always one rule of thumb that most dietitians, nutritionists, researchers and experts agree on; eat more fruits, vegetables, pulses, and whole grains. In the vegetable department, green leafy vegetables get special mention because they are such an important source of so many nutrients. Nuts and seeds are also a rich source of nutrients, but they are also calorically dense, so some caution is warranted if body weight is an issue.
When it comes to nutrition, there is always one rule of thumb that most dietitians, nutritionists, researchers and experts all agree on; eat more fruits, vegetables, pulses, and whole grains.
What is the ideal human diet? This is a highly contested subject, but there is little doubt that the more whole, plant-based food we incorporate into our diet, the more likely we are to attain adequate nutrients. The reason we know this is that studies have shown that people eating meat-free diets tend to get more fiber, more magnesium, more iron, and more vitamin A, B, C, and E, while still consuming fewer calories, on average.[xxii] A dietary pattern based on whole plant food that minimizes sodium, oil and sugar consumption (SOS) is not only a nutrient-dense diet, but it is also a lower calorie diet. This prevents the overconsumption of calories, and the overconsumption of salt and of saturated fat. If you find the idea of strictly plant-based diet too extreme, then at least begin by eating less processed food and less animal-based foods. This will go a long way toward increasing the nutrient density of your diet.
*Legal Disclaimer – This website does not offer medical advice. Always consult your primary health care provider before making changes to your diet. Content is provided for informational purposes only. As a massage therapist, I cannot, and do not personally advise in the area of nutrition. I always defer to the evidence, and to experts in the field. An excellent site for evidence-based advice is Dr. Greger’s non-profit site, www.nutritionfacts.org
[ii] The reason for the fuzziness of this number is because several vitamins include subgroups. For example, the carotenoids consist of six different nutrients (Alpha carotene, Beta carotene, Cryptoxanthin, Lutein, Lycopene and Zeaxanthin), and vitamin B6 has three different forms (Pyridoxine, Pyridoxal and Pyridoxamine). As well, this does not include the ever expanding, newly discovered group on nutrients known as phytonutrients
[iii] Institute of Medicine. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press; 2000. Available from: http://www.nap.edu/openbook.php?record_id=9956&page=R1
[vii] M I McBurney, E A Yu, E D Ciappio et. al. Suboptimal Serum α-Tocopherol Concentrations Observed among Younger Adults and Those Depending Exclusively upon Food Sources, NHANES 2003-2006. PLoS One. 2015; 10(8): e0135510.
[xv] J Hunnicutt, K He, P Xun. Dietary iron intake and body iron stores are associated with risk of coronary heart disease in a meta-analysis of prospective cohort studies. J Nutr. 2014 Mar;144(3):359-66 doi: 10.3945/jn.113.185124.
[xvi] A Fonseca-Nunes, P Jakszyn, A Agudo. Iron and cancer risk–a systematic review and meta-analysis of the epidemiological evidence. Cancer Epidemiol Biomarkers Prev. 2014 Jan;23(1):12-31. doi: 10.1158/1055-9965.EPI-13-0733
[xvii] T K Lam, M Rotunno, B M Ryan, A C Pesatori, P A Bertazzi, M Spitz, N E Caporaso, M T Landi. Heme-related gene expression signatures of meat intakes in lung cancer tissues. Mol Carcinog. 2014 Jul;53(7):548-56. doi: 10.1002/mc.22006.
[xviii] Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, Yang Q, Moshfegh AJ. Sodium and potassium intakes among US adults: NHANES 2003-2008. Am J Clin Nutr. 2012 Sep;96(3):647-57.
[xxii] B Farmer, B T Larson, V L Fulgoni 3rd, A J Rainville, G U Liepa. A vegetarian dietary pattern as a nutrient-dense approach to weight management: an analysis of the national health and nutrition examination survey 1999-2004. J Am Diet Assoc. 2011 Jun;111(6):819-27. doi: 10.1016/j.jada.2011.03.012.