It’s easy to be malnourished

I recently came across a paper analyzing the micronutrient deficiencies in four popular diets – the South Beach Diet, the Atkins for Life Diet, the DASH diet, and the Best Life Diet.

According to this paper [1], none of these diets provides the RDA for more than 15 of the 27 micronutrients studied.  Some nutrients were lacking in all four diets. The diets averaged:

  • 58% of the RDA for pantothenic acid (vitamin B5).
  • 29% of the RDA for biotin.
  • 34% of the RDA for vitamin E.
  • 56% of the RDA for choline.
  • 9% of the RDA for chromium.
  • 34% of the RDA for iodine.
  • 73% of the RDA for potassium.

Of these I would take the chromium and iodine deficiencies very seriously.  These would certainly merit supplementation – indeed, in our book they are among the 8 micronutrients we strongly recommend supplementing.

Cases can also be made for supplementation of others on this list:

  • Biotin and pantothenic acid are harmless in very high doses, and extremely cheap – less than 4 cents for 500 mg pantothenic acid or 5 mg biotin.
  • Choline deficiency is widespread and there is evidence that choline supplements are very helpful for pregnant women.

More important than any specific deficiency, however, is the implication for ordinary diets.  If these comparatively healthy diets are deficient, then nearly any modern diet is likely to produce micronutrient deficiencies.

Agriculture – planting the same crops, year after year, in the same fields – tends to deplete the soil of nutrients, and hence both plant crops and crop-fed animals tend to be low in nutrition. Water treatment also removes minerals like calcium and magnesium from drinking water. 

A British study, for instance, found that copper levels in UK foods have declined by 76% in vegetables, 90% in dairy foods, and 55% in meat. [2] Some other nutrients have declined nearly as much.

It’s important to take some care, therefore, to eat a nourishing diet.  Especially nourishing foods include seaweed, green leafy vegetables, organ meats including liver, and seafoods.

Cooking style is also important:  Cooking should be done in a way that doesn’t throw away drippings from foods, but rather preserves them as a sauce or soup.  Also, very high cooking temperatures which can destroy or denature nutrients should be avoided. 

Even with these steps, supplementation is probably necessary for optimal health.  We recommend taking a daily multivitamin plus a few other supplements, notably including iodine, magnesium, vitamin D, and vitamin K2.

[1] Calton JB. Prevalence of micronutrient deficiency in popular diet plans. J Int Soc Sports Nutr. 2010 Jun 10;7(1):24. Full text:

[2] Thomas D. The mineral depletion of foods available to us as a nation (1940-2002)–a review of the 6th Edition of McCance and Widdowson. Nutr Health. 2007;19(1-2):21-55. Hat tip Robert Andrew Brown,

Leave a comment ?


  1. The Paleo Rodeo #016 - pingback on July 12, 2010 at 5:06 am
  2. What do you think about supplementing with Ubiquinol? Are there foods that can supply what we need, or is the need overblown in today’s supplementation-oriented society?

    Thanks—just ordered the book!

  3. Hi Debbie,

    Ubiquinol/CoQ10 is a very interesting compound.

    A healthy person with a nutritious diet should be able to manufacture all they need. However, many people are not healthy.

    When I developed scurvy 3-4 years ago, I found that CoQ10 was tremendously helpful to me. This is partly because it recycles vitamin C.

    When I realized that I had scurvy, I began a project to understand optimal intake of the various micronutrients, and to test each on myself. Since it takes several months to test each one, it’s taken me 3+ years just to get through the important basic vitamins and minerals. Now that I’ve optimized my diet fairly well, I haven’t had time to test compounds like CoQ10.

    My belief is that CoQ10 on an optimized diet is probably not that helpful, because it is so lipophilic it probably can’t cross all the membranes it would need to get across to enter mitochondria where it would do the most good. So its function would be to sit on outer membranes and recycle vitamins C and E. But if you’re eating a nutritious, low oxidizing diet, endogenous CoQ10 is probably sufficient and supplements won’t provide additional benefit.

    However, people with unhealthy diets may get substantial benefit from it. Of course, anyone taking statins should supplement CoQ10.

    So I would expect that when I do test it, there will be no detectable effect, since my current diet is pretty optimal I think. Since it’s rather expensive, I don’t mind that!

    An interesting possibility would be whether it might have some kind of therapeutic effect in gut diseases. Intestinal cells and immune cells would get the greatest exposure to supplemental CoQ10. I would have to look into whether any research has been done.

  4. Is the 1500 mg preformed vitamin A in Centrum Silver acceptable, since we know that preformed vitamin A competes with vitamin D. The Life Extension Foundation, for example, has totally eliminated preformed vitamin A from their “multi-vitamin” supplement.

  5. Hi Bill,

    I think that’s OK … we like it to be low, but it doesn’t have to be zero. We believe in a 2.5:1 or 3:1 A:D ratio, so ~10-12,000 IU A : 4,000 IU D per day. A little preformed A is OK.

  6. “My belief is that CoQ10 on an optimized diet is probably not that helpful, because it is so lipophilic it probably can’t cross all the membranes it would need to get across to enter mitochondria where it would do the most good.”

    What about LET CoQ10, like Jarrows Formula Q-Absorb.
    From what I understand, it is utilized by the cells via endocitosis. They claim up to 400% better absorption on the label. Some of my friends noticed tremendous difference ASAP. My wife which has 31 and is of good health noticed the big difference in waking up and energy levels after supplementation on every 2nd day (while nursing, which is definitely stressful for woman)

    This should not be surprising as LET appears to work great with some other vitamins like Vitamin C (for instance liveonlabs product) which is claimed to achieve around 100% absorption in the intestines, and they say its comparable to IV administration of vitamin C (with some success stories to back it up and some preliminary research with LET C which gave plasma concentrations significantly higher then that of normal ascorbate).

  7. Hi majkinetor,

    Gotta try it again … It’s very important for the body and harmless to supplement, so if it can actually get where it’s needed then that’s great.

  8. Hi

    The problem for endogenous production of CoQ10 is that it needs bunch of resources:


    This complex, 17 step process, requiring at least seven vitamins (vitamin B2 – riboflavin, vitamin B3 – niacinamide, vitamin B6, folic acid, vitamin B12, vitamin C, and pantothenic acid) and several trace elements, is, by its nature, highly vulnerable. Karl Folkers argues that suboptimal nutrient intake in man is almost universal and that there is subsequent secondary impairment in CoQ10 biosynthesis. This would mean that average or “normal” levels of CoQ10 are really suboptimal and the very low levels observed in advanced disease states represent only the tip of a deficiency “ice berg”.

  9. Also, keep in mind that resource utilization diminsh with age, for instance, its well known that number of SVCT2 receptors are low in old people.

  10. Hi Paul

    I’ve recently begun taking all of the major recommended supplements after doing PHD for approx 6 months. I usually take all of them after a meal. Quite soon after I take them my mouth gets very dry, especially in the back top of my throat, and this doesn’t go away for many hours – drinking water doesn’t relieve it. I never had this problem while doing PHD itself – maybe only in the beginning when I had begun eating low carb but hadn’t discovered PHD yet.

    Here’s what I’m taking, 1 of each unless otherwise noted:

    Carlson Vitamin D3 2000 IU
    Pure Encapsulations Magnesium Citrate 150mg
    Integrative Therapeutics Spectrum 2C multi-vitamin w/o iron (2 capsules)
    Metagenics Ultra Potent C (buffered) 1000 mg
    Jarrow Zinc Balance 15 mg w/ 1 mg copper
    Carlson Selenium 200 mcg
    Source Naturals Chromium Picolinate 200 mcg
    Jarrow MK-7 90 mcg

    Thanks for any help,


  11. Sorry, I posted this on the wrong thread – I meant to put it on Recommended Supplements, but used the wrong tab. If you can/want to move it, feel free. Thank you.

  12. Hi Peter,

    This is a puzzle. I’ve looked again at the Integrative Therapeutics multi and it looks OK. I’ve seen calcium implicated as a possible cause of dry mouth, but it doesn’t seem like your calcium or D dose is large enough to cause that, especially so quickly.

    The only thing I can say is try switching out pills, starting with the multi, to see if you can narrow down the cause.

    Best, Paul

  13. Hi Paul

    I’ve had good success with PHD and would like to pick your brains regarding supplementation.

    I’ve just finished reading a new book called ‘Naked Calories’ by Jason & Mira Carlson.

    The contents of the book are interesting and in synergy with PHD, discussing micronutrient deficiencies in the modern food chain. Suggesting nutrient dense foods and supplementation to correct the problem.

    However a large part of the book is devoted to the supplementation of micronutrients. There book suggest that most vitamins pills are ineffective and can lose up to 80% of their nutrients due to a number of factors:

    1) Poor absorption – the book states that vitamins should be in powder form taken in liquid, not in pill/capsule form

    2) The dose spread out over the day i.e. am /pm as the body can only absorb a certain amount at one time.

    2) Vitamins should be 100 RDI – fair enough!

    3) Should benefit from ‘Competition technology’ and ‘synergy’ to ensure the full benefit of the micronutrients – the premiss being that chemical, biochemical and physiological competition between certain micronutrients in the same pill/dose reduces their effectiveness. In addition, some nutrients need to be take together to be effective.

    The main disappointment of the book or this approach is that from what I can gather the only vitamin product on the market that has all the requirements outlined is only available from the Carlson’s website – mmmmmm!!

    I’m interested to hear your thoughts as to whether there is any validity to the points outlined above.


  14. Hi Brian,

    I would be surprised if all of those claims were valid. Why should the body’s ability to absorb nutrition be so fragile? How can it tell a nutrient taken as a supplement with food from nutrients contained within the food? The ability of pills to dissolve is easily tested.

    That said, there is probably something to it, better ways to take the supplements, competitive and timing effects, and better and worse commercial formulations. I’m not expert in this however.

    Best, Paul

  15. HI Paul

    Thanks for the quick reply.

    Yes, I’m inclined to agree that some of their suggestions are valid and some on more shaky ground.
    I won’t be ordering their product (I’m in the uk so that’s more difficult anyway) but may give soluble vitamins a try.


  16. Hi Paul:

    You may need to consider updating this article to make your suggestions ill-advised in terms of taking a multivitamin.

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