In a nation blessed with abundant food and resources, the prevalence of vitamin deficiencies may seem puzzling. Even with many foods in America containing added vitamins and minerals, such as iodized salt, fortified cereal or fluoride in water, endocrinologists consistently observe an increase in cases of vitamin deficiencies. The key to navigating these deficiencies lies in understanding how surgeries, dietary choices, medications and our bodies’ responses may help us maintain a healthy balance of nutrients.
A notable contributor to the rising tide of vitamin deficiencies is bariatric surgery. These procedures, designed for weight loss purposes, disrupt the body's capacity to absorb essential nutrients. “Not only are patients eating much less, but the diminished surface area of the stomach and intestines, pivotal for efficient absorption, results in deficiencies of vital elements like vitamin D, calcium, B12 and iron. Our bodies literally struggle to catch hold of these crucial nutrients post-surgery. For those undergoing these surgeries, a daily vitamin regimen becomes a lifelong commitment in order to keep health in check and compensate for the reduced nutrient absorption,” said Saraya Landis, physician assistant with Endocrinology at East Tennessee Medical Group.
Yet, our diets and the medications we take also play pivotal roles in balancing nutrients. Vitamin D, for example, is one of the most common vitamin deficiencies in the United States, with up to 50 percent of patients being deficient. “Vitamin D is fat-soluble, so taking these supplements with a fattier meal, such as dinner, will result in better outcomes compared to an empty stomach. And with an increased interest in plant-based diets, many patients may eventually become deficient in B12, a vitamin present in animal protein,” Landis explained. Pairing iron-rich foods with those loaded with vitamin C helps our bodies make the most of plant-based iron.
Even our prescriptions can alter the way we absorb nutrients. Certain medications, such as those for heartburn or diabetes, can deplete magnesium, calcium and B12 levels. Adjusting the dosage or frequency of these medicines can significantly impact maintaining healthy nutrient levels. “Long-term proton pump inhibitors (PPI), such as omeprazole, can deplete magnesium and calcium. Often, just reducing the dose or frequency of the medication can improve levels. Long-term use of metformin often results in B12 deficiency, as well, so these patients should be monitored to ensure adequate supplementation. Corticosteroids and some antibiotics also have been shown to reduce certain vitamins, including K, D, and C, and should be used cautiously and in short intervals,” Landis clarified. In addition, some fat-soluble vitamins can reach toxic levels if too much is taken, so patients should always discuss the supplements they take with their provider.
Sometimes detecting deficiencies isn't straightforward, as there usually aren’t clear signs or symptoms. Health care providers should order tests only when they suspect an issue and are prepared to address it. “Vitamin and mineral deficiencies often result in vague, non-specific symptoms, so a provider should only order these labs when a patient has certain risk factors for malabsorption or depletion and when the provider is prepared to replenish or manage these levels,” Landis added.
For more information to make an appointment with a provider at East Tennessee Medical Group, call 865-984-3864.