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Dynamic Chiropractic – November 8, 2006, Vol. 24, Issue 23
Dynamic Chiropractic
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Dynamic Chiropractic

Clinical Signs and Other Indicators of Vitamin/Mineral Deficiencies

A Simple Test and Educational Exercise for Your Patients

By James P. Meschino, DC, MS

There are a number of well-established clinical signs and symptoms associated with vitamin and mineral deficiencies. All health care practitioners should be aware of these signs/symptoms when evaluating patients.

Additionally, certain nutrition and lifestyle behaviours and the use of certain medications can promote vitamin and mineral deficiencies, usually from lack of intake or accelerated depletion of specific nutrients.

Studies indicate that 91 percent of North Americans do not ingest the RDA levels for each vitamin and mineral on a daily basis. Further, the RDA levels for many nutrients are considered to be suboptimal according to many anti-aging and nutrition experts, especially in regard to certain antioxidants, vitamin D and selenium. An additional complicating factor is that many people engage in dietary and lifestyle behaviours which encourage nutrient loss and/or take medications that impair absorption, or promote excretion and accelerated loss of vitamins and minerals from the body.

Considering the important role played by vitamins and minerals in the prevention of cancer, heart disease, dementia, osteoporosis, cataracts, macular degeneration and other health problems, most adult patients stand to benefit (unless there are contraindications) from taking a high-potency multiple vitamin/mineral each day - one that is antioxidant-enriched, and contains 500 mg of elemental calcium and a B-50 complex.

The following questionnaire is designed to help identify patients who are showing signs of vitamin and mineral deficiencies, as well as those at increased risk for such deficiencies.

Part One: Lifestyle Factors and Clinical Indicators of Vitamin and Mineral Deficiency
  Question Response Feedback for Yes Answers
1. On average, do you eat fewer than five fruit and vegetable servings per day? Yes___ No___ Insufficient intake of fruits and vegetables (less than five servings per day) deprives the body of many necessary nutrients including antioxidants, B vitamins and phytonutrients.
2. Do you often experience a scaly, flaky, seborrheic condition at the outer nose margins above the lips? Yes___ No___ Flaky seborrheic conditions on the face are associated with deficiencies in vitamins B2 and B6.
3. Do you have soft nails or nails that chip, crack or peel easily, and/or are brittle or contain ridges (rather than being smooth)? Yes___ No___ Soft nails or nails that chip, crack or peel easily, and/or are brittle or contain ridges (not smooth), often are caused by deficiencies in calcium and other minerals.
4. Are there white spots under your fingernails? Yes___ No___ White spots under your fingernails often are a sign of zinc deficiency.
5. Have you noticed small red spots under your skin? Yes___ No___ Red spots under the skin often are an indicator of vitamin C deficiency.
6. On average, do you consume more than three alcoholic beverages per week? Yes___ No___ Consuming more than three alcoholic beverages per week, on average, is associated with depletion of the following nutrients:
  • vitamin A
  • beta-carotene and other carotenoids
  • vitamin B1
  • vitamin B2
  • vitamin B3
  • vitamin B6
  • vitamin B12
  • pantothenic acid
  • vitamin C
  • vitamin D
  • vitamin E
  • potassium
Alcohol consumption also produces increased exposure to free radicals.
7. On average, do you drink more than two cups of coffee or caffeinated tea (of any kind) per day? Yes___ No___ Drinking more than two cups of coffee or caffeinated tea (of any kind) per day, on average, depletes the body of vitamin C, many B vitamins and minerals.
8. Are you a smoker? Yes___ No___ Smoking cigarettes increases free-radical exposure and depletes the body of antioxidants, B vitamins and minerals.
9. Has your skin been damaged by sunlight and/or do you use a tanning bed more than once per month? Yes___ No___ Damage to the skin from sunlight and tanning beds results in the production of free radicals and depletion of antioxidants that protect the skin from future ultraviolet light exposure.
10. On a scale of one to five, is the daily stress level in your life three or greater, if one is a low level of stress and five is a high level of stress? Yes___ No___ It appears your stress is at a level sufficient to create hormonal imbalances that can lead to the depletion of vitamin C, many B vitamins and minerals.
11. Do you often experience cracks at the margins of your lips? Yes___ No___ Cracks at the margins of the lips often are associated with vitamin B2 deficiency.
12. Do you often experience a sore or burning tongue? Yes___ No___ A sore or burning tongue often is caused by deficiencies in vitamins B2, B6 and/or B12.
13. Have you experienced a reduced ability to taste food? Yes___ No___ A reduced ability to taste food often is caused by a zinc deficiency.
14. Do your gums bleed easily? Yes___ No___ Gums that bleed easily often signal vitamin C deficiency.
15. Do you bruise easily? Yes___ No___ Skin that bruises easily often is associated with a deficiency in vitamin C, calcium and/or vitamin K.
16. Are you a slow healer from bruises and cuts? Yes___ No___ Slow healing capabilities often indicate suboptimal vitamin C status.
17. Do you feel chronically tired? Yes___ No___ Feeling chronically fatigued in the absence of disease often is associated with multiple vitamin and mineral deficiencies.
18. Do you have irregular eating patterns? Yes___ No___ Irregular eating patterns tend to contribute to an inadequate intake of essential vitamins and minerals, which often leads to at least marginal deficiencies.
19. Are you on a weight-loss or calorie-restricted diet? Yes___ No___ Calorie-restricted diets cannot provide optimal intake levels of all vitamins and minerals, thereby contributing to marginal deficiency states. Individuals on calorie-restricted diets (less than 2,000-2,500 calories per day) are advised to derive the missing nutrients from a multiple vitamin/mineral.
20. Do you feel run down and/or are you experiencing a weakened state of immunity? Yes___ No___ Feeling run down and/or in a weakened state of immunity suggests multiple nutrient deficiencies might be a factor. Studies reveal that supplementation with certain antioxidant vitamins, as well as zinc and selenium, can bolster immune function in older subjects and in those with certain types of compromised immune function.
21. Does your hair fall out easily, and/or is it dry and brittle and/or does it lack optimal lustre and sheen? Yes___ No___ Hair that falls out easily, dry and brittle hair and/or lacklustre hair that is dull in appearance are all associated with multiple vitamin and mineral deficiencies.

Part Two: Drugs Causing Nutrient Depletion
Do you regularly use any of the following medications or agents? Indicate Yes or No beside each item.
1. Laxatives Yes No Your regular use of laxatives is associated with depletion of the following nutrients:
  • vitamin A
  • vitamin D
  • vitamin E
  • calcium
2 Long-term antibiotic therapy Yes No Your regular use of antibiotics is associated with depletion of the following nutrients:
  • vitamin B1
  • vitamin B2
  • biotin
  • pantothenic acid
  • vitamin C
  • vitamin E
  • vitamin K
  • potassium
  • magnesium
  • zinc
3. Cholesterol-lowering drugs: cholestyramine, Colestipol, Questran, Colestid, Atromid-S Yes No Your regular use of cholesterol-lowering drugs is associated with depletion of the following nutrients:
  • vitamin A
  • vitamin B12
  • beta-carotene
  • folic acid
  • vitamin D
  • vitamin E
  • vitamin K
  • iron
4. Anti-gout drug: Colchicine Yes No Your regular use of colchicine to treat gout is associated with depletion of the following nutrients:
  • vitamin A
  • vitamin D
  • vitamin B12
  • folic acid
  • iron
5. Steroid hormones: cortisone, prednisone, etc. Yes No Your regular use of certain steroid drugs is associated with depletion of the following nutrients:
  • folic acid
  • vitamin D
  • zinc
  • magnesium
  • vitamin C
  • calcium
6. Aspirins for arthritis or any other reason (or other nonsteroidal anti-inflammatory drugs: ibuprofen, naproxen, etc. Yes No Your regular use of nonsteroidal anti-inflammatory drugs is associated with depletion of the following nutrients:
  • folic acid
  • vitamin C
  • vitamin K
  • iron
7. Antacids: Maalox, Tums, Mylanta, Rolaids, Diovol, etc. Yes No Your regular use of antacid drugs is associated with depletion of the following nutrients:
  • vitamin A
  • vitamin B1
  • folic acid
  • vitamin B12
  • chromium
  • iron
8. Oral contraceptives Yes No Your regular use of oral contraceptive drugs is associated with depletion of the following nutrients:
  • beta-carotene
  • vitamin B1
  • vitamin B6
  • folic acid
  • vitamin B12
  • biotin
  • pantothenic acid
  • vitamin C
  • magnesium
  • zinc
9. Sedatives/barbiturates: phenobarbital, Fiorinal, Phenaphen, atropine, etc. Yes No Your regular use of sedative and/or barbiturate drugs is associated with depletion of the following nutrients:
  • vitamin B2
  • vitamin C
  • vitamin D
  • folic acid
  • vitamin B12
  • pantothenic acid
10. Estrogen replacement drugs Yes No Your regular use of estrogen replacement therapy is associated with depletion of the following nutrients:
  • vitamin B1
  • vitamin B2
  • folic acid
  • vitamin B12
  • biotin
  • pantothenic acid
  • vitamin C
  • magnesium
  • zinc
11. Caffeine: caffeinated coffee, tea, espresso, etc. Yes No Your regular intake of caffeine is associated with depletion of the following nutrients:
  • vitamin B1
  • potassium
  • zinc
12. Smoking Yes No Your regular habit of smoking is associated with depletion of the following nutrients:
  • vitamin B1
  • folic acid
  • vitamin B12
13. Antidepressants: Prozac, Paxil, Zoloft, Celexa, amitryptyline, etc. Yes No Your regular use of antidepressant drugs is associated with depletion of the following nutrients: vitamin B2 vitamin B6 calcium magnesium coenzyme Q10
14. Amphetamines: Adderall, Cylert, Ritalin, Benedrine, Dexedrine, etc. Yes No Your regular use of amphetamines is associated with depletion of the following nutrients:
  • vitamin B1
15. Levodopa Yes No Your regular use of Levodopa is associated with depletion of the following nutrients:
  • vitamin B6
16. Anticonvulsants: Dilantin, Celontin, Zorontin, carbamazepine, phenobarbital, etc. Yes No Your regular use of anticonvulsant drugs is associated with depletion of the following nutrients:
  • folic acid
  • biotin
  • vitamin D
  • vitamin E
  • zinc
17. Heart medications: digoxin or Digitalis Yes No Your regular use of digoxin is associated with depletion of the following nutrients:
  • vitamin B1
18. Inflammation/pain medications: indomethacin Yes No Your regular use of indomethacin is associated with depletion of the following nutrients:
  • vitamin B1
19. Diuretics: thiazide drugs, hydrochlorothiazide, Moderet, apotrizide, Midamor, etc. Yes No Your regular use of diuretic drugs is associated with depletion of the following nutrients:
  • vitamin B1
  • calcium
  • potassium (thiazide)
  • magnesium
  • zinc
20. High blood pressure, ACE-inhibitor drugs: Captopril, Capoten, Lotensin, Vasotec, Ramipril, Altace, Prinivil Yes No Your regular use of ACE-inhibitor drugs for high blood pressure is associated with depletion of the following nutrients:
  • zinc
21. High blood pressure, beta-blockers: atenolol, metoprolol, propranolol, acebutolol Yes No Your regular use of beta-blocker high blood pressure drugs is associated with depletion of the following nutrients:
  • coenzyme Q10
22. High cholesterol, statin drugs: Lipitor, Crestor, Mevacor, Zocor, Lescol, Pravachol Yes No Your regular use of statin drugs for high cholesterol is associated with depletion of the following nutrients:
  • coenzyme Q10

I believe this questionnaire is a very useful exercise to help patients understand the adverse effects faulty dietary patterns and lifestyle practices have on vitamin and mineral status, as well as the nutrient depletion produced by the use of many drugs.

If you are seeking a more complete nutrition/lifestyle/anti-aging assessment, send your patients to www.naturalhealthtest.com, where they will find a complimentary comprehensive assessment designed by me. The feedback report generated from the 173 questions comprising the questionnaire provides patients and their health care practitioners with an expert opinion regarding dietary modifications, exercise parameters and nutritional supplement combinations that best suit each patient's needs. Practitioners can use this online assessment as a resource to save time with this important aspect of patient management and patient education.


Click here for more information about James P. Meschino, DC, MS.

Dynamic Chiropractic

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