Vitamins are essential nutrients and as such a dietary threshold exists below which a deficiency disease will develop. However, as well as vitamin deficiencies, it is possible to develop a vitamin insufficiency, which is defined as a chronic low intake, that is high enough to prevent an outright deficiency, and yet not high enough to provide optimal metabolic function for that vitamin. While outright vitamin deficiencies are rare, vitamin insufficiencies may be present in most individuals in Western populations on account of the low quality diet eaten. However, detecting vitamin insufficiencies is hard because symptoms are not always clear and the accepted clinical biomarkers for many vitamins can be too insensitive or are not fully understood, and in this regard many vitamin insufficiencies are not easily detectible in a clinical setting. Often more than one marker is available to clinicians and the vagaries of the insufficient state often necessitate their use in combination in order to build a more accurate picture of the vitamin status of the individual.
For example, serum levels of vitamin B12 are directly related to the circulating vitamin B12 levels. Another marker for vitamin B12 however is methylmalonic acid (MMA) a substance that accumulates in the absence of vitamin B12, and this can also be a useful biomarker of vitamin B12 status. However, each of these vitamin B12 markers has limitations that inhibit their sensitivity and specificity. Another problem with determining vitamin status is the one of how to accurately assess the cut off points for a particular status. Traditionally this has been done with a single point to define a deficiency, but improvements in nutritional understanding suggest that multiple cut off points should be included in order to define the sub-optimal range that define the vitamin insufficient status. Using MMA and serum vitamin B12 as markers, one group of researchers assessed the changes to the slope of the lines and used mathematical models to investigate the possibility that an insufficient status could be defined using these two markers1.
The results of this study showed that the data for serum vitamin B12 and methylmalonic acid displayed three distinct slopes when mathematically modelled, suggesting that the traditional cut off point to describe vitamin B12 status (using one inflection point: deficient and sufficient) was flawed. Using the traditional criteria and cut off point would therefore fail to separate the severely deficient group from a less severely insufficient group. Including two inflection points in the criteria however, allows the classification of a separate insufficient group that may present no clear clinical symptoms, and yet who would respond positively to vitamin B12 therapy. As more is learned about this insufficient state and its link to Western disease, it becomes apparent that the vast majority of the Western population fits into this category for multiple micronutrients. This is not surprising given the low quality of the Western diet that most consume. The refined nature of most of the Western foods removes many of the micronutrients and produces low quality junk.
Dr Robert Barrington’s Nutritional Recommendation: If you currently consume a traditional Western diet it is almost certain that you will have multiple micronutrient insufficiencies that will be affecting your health. The symptoms of these will be almost undetectable and may manifest as aches and pains, headaches or other non-specific clinical symptoms that are chronic in nature. Improving the quality of your nutrition by consuming a diet based on traditional eating practices and taking a multivitamin and mineral formula is the best way to reverse the insufficient state.
RdB
