Positive Health Online

Introduction

In this article several aspects shall be examined that can influence or hinder the uptake of the essential micro-nutrients that we must consume in order to maintain optimum health. This statement in itself causes much controversy because we have been led by the media and the government-regulated authorities to believe that as long as we eat a 'balanced diet' we should receive all of the essential nutrients required in order to prevent a 'deficiency disease'.[1] Many eminent authorities in the field of nutrition feel that this is a dangerous and misleading attitude, as it has been shown in numerous studies that there is a strong case for re-evaluation of these levels to much higher recommendations to ensure 'optimum nutrition'. These recommendations are within safety and efficacy guidelines, so as to negate any adverse reactions or side-effects.[2] It has been stated that a change in recommended levels would ensure that a person has an intake-guideline not only to prevent deficiency-onset disease, but possibly a level that would contribute to their health.3 The benefits that could be seen would be wide ranging. These would include boosting the immune-system, supporting homeostasis within the body, detoxification of free-radical damage, and supporting the complex synergy of nutrients that are required for metabolism of the very nutrients required for all bodily functions. "Micro-nutrients are the key to optimal macro-nutrient metabolism because of their essential role in metabolism".[3]

Imbalances in synergy could also have a detrimental effect, and estimations for government recommendations should take this interdependent role into account. Also included shall be some of the many aspects that can disrupt the actual bio-availability of these nutrients, whether they be derived from food sources or supplementation. These disruptive variables can be wide-ranging, from a poor delivery in the first instance, such as is found with highly processed foods, to a poor assimilation within the gut and also complications that can arise from blocking agents such as drugs and alcohol.

The significance that this lack of nutrients can have on physiological functions within the body shall be examined. We shall look at the interaction of several micro-nutrients and how it is vital that they are allowed to function in synergy; otherwise adverse deficiencies can arise even if the basic nutrient is being ingested in adequate amounts.

What are Micro-Nutrients?

Micro-nutrients are nutrients that are required by the body in relatively small amounts, yet they are no less vital for sustaining life than the macro-nutrients. The macro-nutrients are water, carbohydrates, protein and fats. In fact, many of the vitamins, minerals, essential amino-acids and essential fats have a vital role to play in the synthesis of enzymes that are part of the complex internal biochemistry of the human body. When looking to deal with a micro-nutrient deficiency, it would be advisable to appreciate that nutrients work synergistically, a fact that is often overlooked or ignored, when performing scientific studies on an isolated nutrient. This means that there is a co-operative action between certain vitamins, minerals, essential fats and amino acids, as they work as catalysts promoting the absorption and assimilation of other nutrients.

To ensure adequate uptake of any one nutrient it is not simply a case of ingesting a set amount of that vitamin/ mineral. For this reason, nutritionists should always recommend taking a balanced nutrient complex rather than a given nutrient in isolation as a baseline. An example of this would be the role of several of the B vitamins in their role of homocysteine breakdown. High levels of this amino acid metabolite have been proven to be a major contributory factor towards cardio-vascular disease.[4] Treatment to reduce the levels of homocysteine, by means of conversion to cystathionine or remethylation to methione, are dependent upon vitamin B6, B12 and folic acid. This is an example of how the nutrients would work in unison to act as catalysts for amino acid metabolism.[5]

The concept of maximizing nutrient uptake is vital to keep in mind when considering the problems that can be caused through interrupted absorption such as nutrient binding. For instance, the binding and thus lack of absorption of certain minerals which can be caused by ingesting the insoluble mineral salts oxalate and phytate, found in food products such as wheat. This simple example demonstrates that even if the food source, in this case wheat, contains the required nutrient levels to meet our Recommended Nutrient Intake (RNI), we could actually be deficient in these same nutrients due to the fact that their absorption has been jeopardized.

Table 1 lists some selected micronutrients, their primary role in the body, and the other nutrients that are required for their assimilation[6][7]

The list is by no means complete, either in the interaction of synergistic nutrients or in their physiological functions. For example, it is known that the mineral zinc is an active constituent in over 200 different enzymes. It is utilized extensively throughout the body for many functions, such as nucleic acid synthesis, protein digestion, carbohydrate metabolism, dark adaptation, bone formation, oxygen transport, collagen formation, immune system function and for protection against free radical damage. It is also true that this mineral, as vital as it obviously is, tends to be poorly digested and that many factors can further interfere with its absorption and utilization by the body.

It can be seen in Figure 1 that zinc is in fact the essential nutrient, at least of those tested, that is deficient in 49% of the British population. It has been estimated that less than one in ten people are likely to receive even the Reference Nutrient Intake for this vital mineral.8 A more recent survey, The National Diet and Nutrition Survey 2000/2001, of the British population, found levels of retinol, riboflavin, magnesium, potassium, iron and copper all to be below the Reference Nutrient Intake for a significant number of the 2,251 sampled. In fact, retinol, copper and zinc ingested levels were lower than in the 1986/1987 Adult Survey, being the last national survey that the United Kingdom carried out on adults between the ages of 19 and 64.9 It was also noted that women in the 200/2001 survey ingested more of their energy intake from alcohol than in 1986/1987, and as noted previously, this is an anti-nutrient that will flush out many vital micro-nutrients including the already deficient levels of zinc.

It is vital that we consume, from our daily food intake and/or supplementation, not only adequate amounts of each nutrient, but that we also consider them as a synergistic compound, rather than each nutrient in isolation. This would mean analyzing our intake and ensuring that the nutrients were taken in such a balance that they complimented the amount of their interactive nutrients.

In his book, The New Nutrition, Dr Michael Colgan (1995) states that "we know that 13 vitamins, 22 minerals, six co-factors (helper substances), eight amino acids (plus three more in certain circumstances), and two essential fatty acids are required for optimal bodily function".

All these essential substances interact with each other in precise synergy to produce, maintain and renew your body. "If even one is missing, or in short supply, then the functions of all the others are impaired." [10]

People are Different

One of the things that seems to be overlooked when recommending a nutrient is that everyone is an individual, with a different genetic make-up and thus a differing ability to digest and absorb nutrients. Of course, when giving suggestions to a wide ranging population this cannot be fully catered for, but perhaps it should be recommended that individual biochemical and genetic differences will greatly affect a person's nutrient requirement. Also, lifestyle and activity levels have been seen to deplete the stores of certain nutrients within the body, and therefore a greater intake is required. An example of this would be seen in a person who exercises frequently, or undergoes any other form of stress that can deplete nutrient stores. It has been shown that such stress depletes stores of nutrients, including the amino acid glutamine which is essential to the immune system, the digestive system, for brain neurotransmitters and a variety of other bodily functions.[11]

During the late 1960s four researchers, working independently, arrived at the same conclusion – that new nutritional principles should be looked into to bring about a healthier general population. Dr Linus Pauling, a multiple Nobel Prize winner, developed the concept of 'Orthomolecular Medicine'. This basically means "the right molecule in the right concentrations at the right time for the best health."[12] Dr Roger Williams completed his concept of 'biochemical individuality', which recognizes the fact that each of us is extraordinary and has specific nutritional needs due to genetic factors that differ from the average.[13] Dr Emanuel Cheraskin developed the concept of 'optimal dietary intake'; this recognizes the truism that there is a nutrient intake level that produces above-average health, something that we should all strive for.[14] The final researcher of this group was Dr Richard Passwater, a highly respected biochemist specializing in the field of health-care. He developed the concept of 'supernutrition', which is in essence similar to Dr Cheraskin's 'optimal dietary intake' but takes a more prospective approach rather than a retrospective one.[15] He has also done extensive work in the field of nutritional medicine and the use of natural nutrients to improve a person's health status.

As their work developed, these four eminent experts realized that they were all striving for the same end result; they were all approaching it from different directions – yet reaching the same conclusions.

Digestive Problem Considerations

When looking at the available level of micro-nutrients in the system it is the amount of the nutrient that is absorbed that is more relevant than the amount ingested. Various factors can influence this uptake of the ingested nutrient, not least a less than optimal digestive system. There are numerous digestive disorders that will hinder maximal nutrient absorption. Many of these disorders are often overlooked, especially by those with no nutritional training. One such condition is increased gut-permeability, commonly referred to as 'leaky gut syndrome'. This problem is much more prevalent than many would imagine, partly due to the increasing use of modern medications.[16]

The definition of this disorder is 'an abnormal increase in permeability of the intestinal mucosa to luminal macromolecules, antigens and toxins associated with inflammatory, degenerative and/or atropic mucosal damage'.[17] Increased permeability of the intestinal lining can be contributed to by several factors. These include consumption of alcohol, frequent use of non-steroidal anti-inflammatory drugs, such as aspirin, gastrointestinal infection or infestation and a lack of key nutrients such as zinc and essential fatty acids.

The complications arising from this condition are many, including food allergies, inflammatory bowel disease, impaired immune function and improper digestion of nutrients. An example that demonstrates the importance of a healthy intestinal tract for the absorption of nutrients is the study by Hathcock and Troendle.[18]

This study showed that any process that disrupts the normal function of the mucosal lining, including bacterial overgrowth in that area, will reduce the uptake of many nutrients including vitamin B12. Also Dr Russell19 of the Tufts University in Boston, USA has reported on the prevalence of atrophic gastritis in those over 60 years of age, with 22% having seriously reduced acid production whilst 11% have no secretion at all. This atrophic gastritis results in the reduced output of hydrochloric acid, pepsinogen and intrinsic factor, all of which are required for B12 absorption and subsequent utilization. Dr Russell also states that this reduced stomach secretion can result from conventional drug-treatment, further jeopardizing nutrient uptake.

All nutrients have a specific uptake site within the gastro-intestinal tract. This system can no longer function correctly when the mucosal lining is degraded. As it progresses through the gastro-intestinal tract by means of peristalsis, the bolus of food passes various uptake sites that will accept certain nutrients. The duodenum is the area in which the majority of mineral absorption takes place. The jejunum is the area in which water soluble vitamins, namely the B vitamins and vitamin C, are absorbed, along with the amino acids and saccharides. The ileum is the absorption area for the fat soluble vitamins, namely vitamins A, D, E and K and lipids. Finally the electrolytes sodium, potassium, calcium, phosphorous, and magnesium are absorbed in the colon. If, for any reason, the function of the digestive system is impaired, then this site-specific absorption can be hindered.

This in turn would lead to a deficiency of the affected micronutrients, even though they will have been ingested. This could lead to a person believing that they have adequate amounts of a specific nutrient, unaware that it has not been absorbed and utilized. Studies, as shown in Figure 1, are based on estimated intake of nutrients from food sources, assuming that that food has consistent levels of delivery, and does not actually assess the subject's uptake of nutrients, considering poor absorption rates, etc.

Other factors can lead to the same scenario, such as low stomach acid production, as found in the elderly.19 This would lead to several problems of incomplete digestion as well as poor nutrient uptake. It is an essential requirement, for instance, that hydrochloric acid and pepsin liberate vitamin B12 from its protein binders where intrinsic factor allows it to bind to a specific receptor site on the brush border membrane of the ileum. A bacterial imbalance within the small intestine can also lead to B12, along with other micro-nutrients, being poorly absorbed and thus a deficiency could arise.

Drug Interactions with Nutrients

Throughout history many natural nutrients such as vitamins, minerals, herbs and other phyto-nutrients have been used to treat illness with great success yet we now consider it a type of 'alternative' medicine. Dating as far back as history has been recorded we find mention of natural compounds, many utilizing the previously mentioned synergistic effect. These were used to treat a wide array of ailments, predominately with no side-effects.

The ancient Greek physician Hippocrates, considered to be the founder of modern medicine, was noted for his natural approach to treating his patients. He studied the person's environmental influences and their dietary intake and utilized his findings to formulate a suitable programme, often suggesting dietary adjustments and use of natural nutrient combinations.

He recognized the harm that nutrient deficiencies could impart on a person's physiology and also the damage created by toxins, both from environmental sources and by those ingested. It is an unfortunate reality that in the modern world people are much more likely to take prescription medication than a natural alternative.

This attitude could explain the increasing prevalence of problems caused by the side-effects of such drugs. Many of the prescription drugs available have been derived from a natural compound, such as herbs and phytonutrients. In order to isolate a specific compound, thereby negating any synergistic effect, scientists often have to chemically alter the structure of the original source. There are people who would suggest that drug companies have a vested interest in this process as it allows them to patent the final product, something that cannot be done with a natural compound.

In Table 2 are some of the interactions of commonly used medications with micro-nutrients, which would in effect reduce the action of the micro-nutrient in the body even if ingested in adequate amounts and fully absorbed and assimilated.[20]

In addition to the above prescription medication interaction, it should be considered important to recognize the fact that many other factors interfere with nutrient uptake. These would include stress, caffeine, alcohol, smoking, pollutants, toxic metals, pesticides, food additives and even some foods that contain natural anti-nutrients. An example of the latter can be seen in wheat bran, which is widely promoted as a health food yet it is rich in phytic acid, which is known to inhibit mineral absorption.[21]

Of course there are conditions that require the use of prescription medication and this should by no means be questioned. It may, however, be beneficial to the patient to consider alternatives if the ailment is of a minor nature, or to suggest an increased intake of any nutrient that may be depleted due to the antagonistic effect of the required medication.

Figure 1 demonstrates the lack of adequate nutrition that we, as a general population, receive. The study was carried out by the Ministry of Agriculture, Fisheries and Food (MAFF) in 1995. This is the very same authority that is partly responsible for establishing and promoting the suggested intake levels within Great Britain.

Even though these levels have clearly been established to counteract any possibility of a deficiency disease, some of the produced literature that accompanies these figures can be misleading. For example, the British Nutrition Foundation, in conjunction with MAFF, state in their information literature that "the RNI is the amount of a nutrient that will satisfy the needs of practically all the population".[22] The MAFF Manual Of Nutrition expands on this statement and concludes that "…the RNI is much higher than most people need, and in practice it is very unlikely that anyone consuming this much will be deficient in that nutrient."1 There are many other factors to consider when ensuring maximal delivery and utilization of nutrients, in addition to merely calculating dietary intake. This in itself is an impossible task to complete accurately due to the huge variations in nutrient concentration of foods.

The nutrient concentration of a food source will be influenced by factors such as the climate in which it was produced, the nutrient content of the earth in which the food was grown, or the feed used for animal produce, the time and conditions of storage before consumption and various other factors, including the damage caused by the use of pesticides and herbicides.

It is quite a different matter to fully satisfy one's requirement for nutrients to that of merely being absent of deficiency onset diseases. Figure 1 shows quite clearly that we are not even attaining the levels of nutrients to prevent deficiency onset disease. We cannot, therefore, be receiving optimal levels to account for the previously stated extra demand created by toxins, poor digestive function, genetic individuality, variation in food concentration and many more contributory factors.

Conclusion

It is true to say that there are many opposing and controversial opinions when assessing nutritional requirements. Some favour the Reference Nutrient Intake, while others consider that higher recommendations should be set in order to achieve optimal health. Literature is constantly being updated, with recommendations that are within safety and efficacy guidelines yet suggest an increased intake, including levels given for both long-term and short-term use.[23][2] It cannot be denied that micro-nutrients have a vital role in our complex biochemical functioning. There are many factors that can prevent an optimal level of nutrients from being utilized. These would include an inadequate amount of the nutrient being ingested, prevention of uptake due to anti-nutrients, less than optimal digestion and assimilation due to physiological ailments such as gastro-intestinal tract degradation, and a prevention of the synergistic action required due to absence or deficient levels of interactive nutrients. The issue of individual requirements for Micro-Nutrients is of great importance to a person's health status and has been extensively studied; yet the information does not appear to be readily available to the general public, or indeed many medical practitioners. Sub-clinical deficiencies of micro-nutrients can have profound effects on the health and optimal biochemical functioning of the body.

It is suggested that due to the important role that micro-nutrients play in biochemical processes within the body, that we should consider these nutrients in unison rather than in isolation. It is by establishing this attitude, whilst considering factors that can negate nutrient uptake, that we can maximize our physiological functions and, in turn, our health.

References

1. Ministry of Agriculture, Fisheries and Food. Manual of Nutrition. 10th Edition. London. The Stationary Office. 1996.
2. Hathcock J. Vitamins and Minerals: Efficacy and Safety. American Journal of Clinical Nutrition. 66, 427-437. 1997.
3. Lachance PA. Overview of key nutrients: micronutrient aspects. Nutr Rev. 56: S34-9. Review. 1998.
4. Nygard O et al. Total Plasma Homocysteine and Cardiovascular Risk Profile. The Hordland Homocysteine Study. Journal of the American Medical Association. 15: 274, 1526-1533. 1995.
5. Ubbink J et al. Vitamin B12, Vitamin B6 and Folate Nutritional Status in Men with Homocysteinemia. American Journal of Clinical Nutrition. 57: 1, 47-53. 1993.
6. Dr Balch JF and Balch PA. Prescription for Nutritional Healing. 2nd Edition. New York. USA. Avery Publishing Group. 1997.
7. Dr Garrow GS and Dr James WPT. Human Nutrition and Dietetics. 9th Edition. New York. USA. Churchill Livingstone. 1998.
8. Holford P. Optimum Nutrition. Volume 9. Number 4. London. England. ION Press. 1996.
9. Hoare J and Henderson L. National Diet and Nutrition Survey. Adults Ages 16 to 64 Years. Volume 5. TSO. London. England. 2004.
10. Levander OA and Cheng L. Micronutrient Interactions – Vitamins, Minerals and Hazardous Elements. New York. USA. Academy of Sciences. 1980.
11. Keast D, Arstein D, Harper W, Fry RW and Morton AR. Depression of Plasma Glutamine Concentration after Exercise Stress and its Possible Influence on the Immune System. Medical Journal of Australia. 162:15-18. 1995.
12. Dr Pauling L. Vitamin C and the Common Cold. San Francisco. USA. Freeman and Company. 1970.
13. Williams RJ. You are Extra-Ordinary. New York. USA. Pyramid Books. 1967.
14. Cheraskin E, Ringsdorf WM and Brecher A. Psychodietetics. New York. USA. Stein and Day. 1974.
15. Dr Passwater RA. Supernutrition: Megavitamin Revolution. New York. USA. Dial Press. 1975.
16. Brzeski M, Madhok R and Capell HA. Evening Primrose Oil Patients with Rheumatoid Arthritis and Side Effects of Non-Steroidal Anti-Inflammatory Drugs. British Journal of Rheumatology. 30: 371-372. 1991.
17. Institute for Optimum Nutrition. Advanced Nutrition Qualification Course Handbook. London. England. 1996.
18. Hathcock JN and Troendle G.J. 1991. Vitamin B12 Analogues and Intestinal Bacteria. Nutrition Review. 37: 45-47. 1989.
19. Russell RM. Gastric Hypochlorhydria And Achlorhydria in Older Adults. Journal of the American Medical Association. 278: 20, 1659-1660. 1997.
20. Holford P. Optimum Nutrition Workbook. 3rd Edition. London. England. ION Press. 1995.
21. Holford P. Optimum Nutrition. Volume 10. Number 3. London. England. ION Press. 1997.
21. Holford P. The Optimum Nutrition Bible. London. England. Judy Piatkus Limited. 1997
22. British Nutrition Foundation. Nutrition Facts. London. England. 1997.
23 Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes For Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Chlorine. Washington DC. USA. National Academy Press. 1998.

Table 1, 2 and Figure 1 not shown here.