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Nutritional Evaluation:


General fatigue is one of the main ways we perceive ageing. We all feel tired one time or another. Feeling fatigued is not a sign of ill health but it is the degree of fatigue which should call for an evaluation. One component of such an evaluation is nutritional testing. Studies show that a majority of Americans lack essential nutrients. Proper testing and appropriate supplementation can dramatically improve fatigue and quality of life. A comprehensive nutritional evaluation may or may not be fully covered by insurance companies and there is some cost attached to it but benefits of testing followed by appropriate supplementation pay dividends and are worth the cost. Therefore, I do recommend this test. Even if a comprehensive evaluation is not covered, basic components of such assessment are usually covered. Below is an example of such an evaluation followed by a description of the causes of deficiencies, signs of deficiencies and sources of individual nutritional components. 







Below are some of the components of advanced nutritional testing and natural dietary sources to obtain these nutrients:

  1. Vitamin A - (minimum daily need - 3000 IU)

    • Beta-carotene & other carotenoids are converted to vitamin A (retinol), involved in vision, antioxidant & immune function, gene expression & cell growth.

    • Vitamin A deficiency may occur with chronic alcoholism, zinc deficiency, hypothyroidism, or oral contraceptives containing estrogen & progestin.

    • Deficiency may result in night blindness, impaired immunity, healing & tissue regeneration, increased risk of infection, leukoplakia or keratosis.

    • Food sources include cod liver oil, fortified cereals & milk, eggs, sweet potato, pumpkin, carrot, cantaloupe, mango, spinach, broccoli, kale & butternut squash

  2. Vitamin B1 - (minimum daily need - 10 mg)

    • B1 is a required cofactor for enzymes involved in energy production from food, and for the synthesis of ATP, GTP, DNA, RNA and NADPH

    • Low B1 can result from chronic alcoholism, diuretics, digoxin, oral contraceptives and HRT, or large amounts of tea & coffee (contain anti-B1 factors).

    • B1 deficiency may lead to dry beriberi (e.g., neuropathy, muscle weakness), wet beriberi (e.g., cardiac problems, edema), encephalopathy or dementia.

    • Food sources include lentils, whole grains, wheat germ, Brazil nuts, peas, organ meats, brewer's yeast, blackstrap molasses, spinach, milk & eggs.

  3. Vitamin B2 - (minimum daily need - 10 mg)
    • B2 is a key component of enzymes involved in antioxidant function, energy production, detoxification, methionine metabolism and vitamin activation.
    • Low B2 may result from chronic alcoholism, some anti-psychotic medications, oral contraceptives, tricyclic antidepressants, quinacrine or adriamycin
    • B2 deficiency may result in oxidative stress, mitochondrial dysfunction, low uric acid, low B3 or B6, high homocysteine, anemia or oral & throat inflammation.
    • Food sources include milk, cheese, eggs, whole grains, beef, chicken, wheat germ, fish, broccoli, asparagus, spinach, mushrooms and almonds.
  4. Vitamin B3 - (minimum daily need - 20 mg)
    • B3 is used to form NAD and NADP, involved in energy production from food, fatty acid & cholesterol synthesis, cell signalling, DNA repair & cell differentiation.
    • Low B3 may result from deficiencies of tryptophan (B3 precursor), B6, B2 or Fe (cofactors in B3 production), or from long-term isoniazid or oral contraceptive use.
    • B3 deficiency may result in pellagra (dermatitis, diarrhea, dementia), neurologic symptoms (e.g., depression, memory loss), bright red tongue or fatigue. 
    • Food sources include poultry, beef, organ meats, fish, whole grains, peanuts, seeds, lentils, brewer's yeast and lima beans.
  5. Vitamin B5
  6. Vitamin B6 - (minimum daily need - 10 mg)
    • B6 (as P5P) is a cofactor for enzymes involved in glycogenolysis & gluconeogenesis, and synthesis of neurotransmitters, heme, B3, RBCs and nucleic acids
    • Low B6 may result from chronic alcoholism, long-term diuretics, estrogens (oral contraceptives and HRT), anti-TB meds, penicillamine, L-DOPA or digoxin.
    • B6 deficiency may result in neurologic symptoms (e.g., irritability, depression, seizures), oral inflammation, impaired immunity or increased homocysteine.
    • Food sources include poultry, beef, beef liver, fish, whole grains, wheat germ, soybean, lentils, nuts & seeds, potato, spinach and carrots.
  7. Vitamin B7 - (minimum daily need - 100 mcg)
    • Biotin is a cofactor for enzymes involved in functions such as fatty acid synthesis, mitochondrial FA oxidation, gluconeogenesis and DNA replication & transcription.
    • Deficiency may result from certain inborn errors, chronic intake of raw egg whites, long-term TPN, anticonvulsants, high-dose B5, sulfa drugs & other antibiotics.
    • Low levels may result in neurologic symptoms (e.g., paresthesias, depression), hair loss, scaly rash on face or genitals or impaired immunity.
    • Food sources include yeast, whole grains, wheat germ, eggs, cheese, liver, meats, fish, wheat, nuts & seeds, avocado, raspberries, sweet potato and cauliflower.
  8. Vitamin B9 - (minimum daily need - 400 mcg)
    • Folic acid plays a key role in coenzymes involved in DNA and SAMe synthesis, methylation, nucleic acids & amino acid metabolism and RBC production.
    • Low folate may result from alcoholism, high-dose NSAIDs, diabetic meds, H2 blockers, some diuretics and anti-convulsants, SSRIs, methotrexate, trimethoprim, pyrimethamine, triamterene, sulfasalazine or cholestyramine .
    • Folate deficiency can result in anemia, fatigue, low methionine, increased homocysteine, impaired immunity, heart disease, birth defects and CA risk.
    • Food sources include fortified grains, green vegetables, beans & legumes.
  9. Vitamin B12 - (minimum daily need - 100 mcg)
    • B12 plays important roles in energy production from fats & proteins, methylation, synthesis of hemoglobin & RBCs, and maintenance of nerve cells, DNA & RNA.
    • Low B12 may result from alcoholism, malabsorption, hypochlorhydria (e.g., from atrophic gastritis, H. pylori infection, pernicious anemia, H2 blockers, PPIs), vegan diets, diabetic meds, cholestyramine, chloramphenicol, neomycin or colchicine.
    • B12 deficiency can lead to anemia, fatigue, neurologic symptoms (e.g., paresthesias, memory loss, depression, dementia), methylation defects or chromosome breaks.
    • Food sources include shellfish, red meat poultry, fish, eggs, milk and cheese.
  10. Vitamin C - (minimum daily need - 250 mg)

    • Vitamin C is an antioxidant (also used in the regeneration of other antioxidants). It is involved in cholesterol metabolism, the production & function of WBCs and antibodies, and the synthesis of collagen, norepinephrine and carnitine

    • Deficiency may occur with oral contraceptives, aspirin, diuretics or NSAIDs.

    • Deficiency can result in scurvy, swollen gingiva, periodontal destruction, loose teeth. sore mouth, soft tissue ulcerations, or increased risk of infection.

    • Food sources include oranges, grapefruit, strawberries, tomato, sweet red pepper, broccoli and potato.

  11. Vitamin D - (minimum daily need - 400 IU)

    • Vitamin D is a hormone produced in the skin during exposure to sunlight or consumed in the diet, and converted to its active form, calcitriol, in the liver and kidneys.  Vitamin D helps regulate serum calcium and phosphorus levels by increasing intestinal absorption of calcium and stimulating tubular reabsorption of calcium.  Vitamin D also affects numerous other functions in the body.

    • Calcitriol or vitamin D deficiency can result in rickets or osteomalacia due to under-mineralization of the growing skeleton or demineralization of the adult skeleton, respectively. Hypovitaminosis D also increases the risk of infection, cancer, autoimmune disease, hypertension, arteriosclerosis, diabetes and/or insulin resistance, musculoskeletal pain, epilepsy, and migraine.

  12. Vitamin E - (minimum daily need - 100 mcg)

    • Alpha-tocopherol (body's main form of vitamin E) functions as an antioxidant, regulates cell signalling, influences immune function and inhibits coagulation.

    • Deficiency may result in peripheral neuropathy, ataxia, muscle weakness, retinopathy, and increased risk of CVD, prostate cancer and cataracts.

    • Deficiency may occur with malabsorption, cholestyramine, colestipol, isoniazid, orlistat, olestra and certain anti-convulsants (e.g., phenobarbital, phenytoin).

    • Food sources include oils (olive, soy, corn, canola, safflower, sunflower), eggs, nuts, seeds, spinach, carrots, avocado, dark leafy greens and wheat germ.

  13. Alpha lipoic acid - (minimum daily need - 50 mg)

    • α-Lipoic acid plays an important role in energy production, antioxidant activity (including the regeneration of vitamin C and glutathione), insulin signalling, cell signalling and the catabolism of α-keto acids and amino acids.

    • Optimal levels of α-lipoic acid may improve glucose utilization and protect against diabetic neuropathy, vascular disease and age-related cognitive decline.

    • Deficiency can result from an excessive toxic burden and an unhealthy lifestyle. High biotin intake can compete with lipoic acid for cell membrane entry.

    • Main food sources include organ meats, spinach and broccoli. Lesser sources include tomato, peas, Brussels sprouts and brewer's yeast.

  14. Coenzyme Q 10 - (minimum daily need - 30 mg)

    • CoQ10 is a powerful antioxidant that is synthesized in the body and contained in cell membranes. CoQ10 is also essential for energy production & pH regulation.

    • CoQ10 deficiency may occur with HMG-CoA reductase inhibitors (statins), several anti-diabetic medication classes (biguanides, sulfonylureas) or beta blockers.

    • Main food sources include meat, poultry, fish, soybean, canola oil, nuts and whole grains. Moderate sources include fruits, vegetables, eggs and dairy.

  15. Glutathione 

    • Glutathione (GSH) is composed of cysteine, glutamine & glycine. GSH is a source of sulfate and plays a key role in antioxidant activity and detoxification of toxins.

    • GSH requirement is increased with high-fat diets, cigarette smoke, cystinuria, chronic alcoholism, chronic acetaminophen use, infection, inflammation and toxic exposure.

    • Deficiency may result in oxidative stress & damage, impaired detoxification, altered immunity, macular degeneration and increased risk of chronic illness.

    • Food sources of GSH precursors include meats, poultry, fish, soy, corn, nuts, seeds, wheat germ, milk and cheese.

  16. Magnesium - (minimum daily need - 3 mg)

    • Magnesium is involved in >300 metabolic reactions. Key areas include energy production, bone & ATP formation, muscle & nerve conduction and cell signalling.

    • Impaired absorption of Mn may occur with excess intake of Fe, Ca, Cu, folic acid, or phosphorous compounds, or use of long-term TPN, Mg-containing antacids or laxatives.

    • Deficiency may result in impaired bone/connective tissue growth, glucose & lipid dysregulation, infertility, oxidative stress, inflammation or hyperammonemia.

    • Food sources include whole grains, legumes, dried fruits, nuts, dark green leafy vegetables, liver, kidney and tea.

  17. Manganese - (minimum daily need - 400 mg)

    • Manganese plays an important role in antioxidant function, gluconeogenesis, the urea cycle, cartilage & bone formation, energy production and digestion.

    • Deficiency may occur with malabsorption, alcoholism, hyperparathyroidism, renal disorders (wasting), diabetes, diuretics, digoxin or high doses of zinc.

    • Low Mg may result in muscle weakness/spasm, constipation, depression, hypertension, arrhythmias, hypocalcemia, hypokalemia or personality changes.

    • Food sources include dark leafy greens, oatmeal, buckwheat, unpolished grains, chocolate, milk, nuts & seeds, lima beans and molasses.

  18. Molybdenum - (minimum daily need - 75 mcg)

    • Molybdenum is a cofactor for enzymes that convert sulfites to sulfate, and nucleotides to uric acid and that help metabolize aldehydes & other toxins

    • Low Mo levels may result from long-term TPN that does not include Molybdenum.

    • Mo deficiency may result in increased sulfite, decreased plasma uric acid (and antioxidant function), deficient sulfate, impaired sulfation (detoxification), neurologic disorders or brain damage (if severe deficiency).

    • Food sources include buckwheat, beans, grains, nuts, beans, lentils, meats and vegetables (although Mo content of plants depends on soil content).

  19. Zinc - (minimum daily need - 10 mg)

    • Zinc plays a vital role in immunity, protein metabolism, heme synthesis, growth & development, reproduction, digestion and antioxidant function

    • Low levels may occur with malabsorption, alcoholism, chronic diarrhea, diabetes, excess Cu or Fe, diuretics, ACE inhibitors, H2 blockers or digoxin.

    • Deficiency can result in hair loss and skin rashes, also impairments in growth & healing, immunity, sexual function, taste & smell and digestion.

    • Food sources include oysters, organ meats, soybean, wheat germ, seeds, nuts, red meat, chicken, herring, milk, yeast, leafy and root vegetables.

  20. Essential Fatty Acids - Omega 3 and 6 - (minimum daily need - 500 mg)

    • Omega-3 (O3) and Omega-6 (O6) fatty acids are polyunsaturated fatty acids that cannot be synthesized by the human body. They are classified as essential nutrients and must be obtained from dietary sources.

    • The standard American diet is much higher in O6 than O3 fatty acids. Deficiency of EFAs may result from poor dietary intake and/or poor conversion from food sources.

    • EFA deficiency is associated with decreased growth & development of infants and children, dry skin/rash, poor wound healing, and increased risk of infection, cardiovascular and inflammatory diseases.

    • Dietary sources of the O6 Linoleic Acid (LA) include vegetable oils, nuts, seeds and some vegetables. Dietary sources of the O3 a-Linolenic Acid (ALA) include flaxseeds, walnuts, and their oils. Fish (mackerel, salmon, sardines) are the major dietary sources of the O3 fatty acids EPA and DHA. 

  21. Essential and non-essential amino acids

    • Amino acids are building blocks of proteins in all tissues in the body. Deficiencies in certain amino acid levels can cause a variety of health problems.

  22. Amino acid metabolites

    • These are breakdown products of amino acids and are measured as a part of the nutritional evaluation. An imbalance indicates metabolic dysfunction or underlying disorders.

  23. Neurotransmitter metabolites

    • Measurement of neurotransmitter metabolites in the nutrition assessment helps to understand what factors might be contributing to disorders related to neurotransmitter imbalance such as depression, anxiety, mood problems, focus problems, movement disorders etc. 

  24. Dietary peptides

    • These reflect the metabolism of proteins and amino acids in an indirect way. 

  25. Markers of oxidative stress such as 8-OHDG

    • We all have some degree of oxidative stress which is the burden of metabolism our bodies need to undertake to stay functional. High levels of oxidative stress are associated with a fast ageing process. If we can tilt the balance between antioxidants and oxidative stress in a healthy direction, we can slow down our ageing process. In order to monitor our progress, we can measure markers of oxidative stress. One such marker is 8-OH-DG

  26. Need for Probiotics

    • Nutritional evaluation can provide indirect information related to need for probiotics.

  27. Need for Pancreatic enzymes

    • Measurement of nutritional components can provide information related to whether or not there is an insufficiency of pancreatic function and therefore need for supplementation. 


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