Well Fed but Undernourished: An American Epidemic

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Despite an abundant food supply, research indicates that Americans are significantly deficient in many critical nutrients. Several factors are responsible for the “well fed but undernourished” epidemic sweeping the nation, including a high intake of processed foods, declining levels of nutrients in our soils, and the increasing prevalence of chronic health conditions that influence nutrient needs. Read on to learn about the epidemic of undernourishment in the United States and other parts of the developed world and how you can help your clients maximize their nutrient intake to create a foundation for lasting health.

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Nutrient Deficiency: Not Just a Problem in Developing Countries

Malnutrition is a serious public health problem in the developing world and has received much attention from governments and health agencies. Insufficient intakes of total calories, protein, iodine, iron, vitamin A, and zinc are just a few of the nutritional deficiencies that plague people living in developing countries.

The developed world, on the other hand, has long considered itself immune to the problem of malnutrition due to food fortification programs and an overabundant food supply. In the United States, “the land of plenty,” calories are not hard to come by; in fact, the average American consumes a whopping 3,600 calories per day, a 24 percent increase from 1961! (1) However, emerging research demonstrates that despite being extremely well fed calorically speaking, Americans suffer from a wide range of nutrient deficiencies with significant health implications. (2)

More than half the calories Americans consume come from nutrient-depleted, ultra-processed foods, including refined flours and industrial seed oils. It comes as no surprise that so many people are undernourished

A recent study conducted as part of the National Health and Nutrition Examination Survey (NHANES) indicates that U.S. children and adults have high rates of deficiency of vitamins A, B6, B12, C, D, E, and folate, as well as the mineral iron. (3) In the study, nutrient intake data is expressed as the percent of individuals with inadequate nutrient intake relative to the Estimated Average Requirement (EAR) and the Recommended Dietary Allowance (RDA). The EAR is the nutrient intake value estimated to meet the requirement of half of healthy individuals in a group, whereas the RDA is the average level of intake sufficient to meet the nutrient requirements of 97 to 98 percent of healthy people. The RDA, therefore, has a higher value than the EAR for any given nutrient. Based on this data, the researchers found that nutrient deficiencies are extremely prevalent in the United States. (4, 5)

  • Nearly one-third (31 percent) of the U.S. population is at risk for at least one vitamin deficiency or anemia.
  • 23 percent, 6.3 percent, and 1.7 percent of Americans are at risk of anemia or deficiency of one, two, or three to five vitamins, respectively.
  • 1 percent of American adults have an insufficient vitamin A intake.
  • 32 percent have an insufficient vitamin B6 intake.
  • 1 percent are not getting enough vitamin B12.
  • 3 percent have an inadequate intake of folate.
  • 1 percent have an insufficient intake of vitamin C.
  • 4 percent are not getting enough vitamin E.
  • 3 percent have an inadequate iron intake.
  • 95 percent of adults and 98 percent of teens have an inadequate vitamin D intake.
  • 61 percent of adults and 90 percent of teens don’t get enough magnesium.

The researchers wrapped up their discussion of these shocking statistics by stating that “a low proportion of the U.S. population has an adequate diet.” (6) This discovery goes against the commonly held belief that malnutrition is a rarity in the United States. To make matters worse, the statistics presented in this study may represent an underestimation of the true scope of nutrient deficiency in the United States for several reasons:

The RDA is the nutrient intake required to avoid acute symptoms, not the nutrient intake required to promote optimal health. For example, while an individual may have an intake of vitamin C sufficient to prevent scurvy, he may require an even greater intake of vitamin C if his goals are to fortify his body against oxidative stress and achieve a high level of health.

The RDAs don’t consider the activity level or presence of chronic health conditions in individuals, situations that may necessitate a higher nutrient intake. Someone who is very physically active or dealing with a chronic illness may require a higher nutrient intake than a sedentary or disease-free individual.

The RDA does not consider nutrient synergy. Many nutrients require the presence of other nutrients to be utilized by the body. For example, vitamin D assists in the intestinal absorption of calcium, and a deficiency of vitamin D increases the need for calcium. Adhering to the RDA without considering these nutrient synergies may lead to imbalances in nutrient intake.

Environment affects nutrient needs. For example, someone living in an environment situated above 37 degrees north latitude will need more dietary vitamin D than someone living further south, due to the significantly reduced ability of the skin to make vitamin D from sun exposure at higher latitudes.

RDAs and EARs are established based on the needs of “healthy” individuals. Considering that one in two Americans has a chronic disease and one in four has multiple chronic diseases, the categories of “healthy” individuals included under the RDA and EAR may encompass people who aren’t that healthy at all. Therefore, nutrient intakes required to promote optimal health may be higher than what is currently represented by the RDA and EAR.

The health implications of these nutrient deficiencies cannot be understated. For example, vitamin A deficiency reduces immune system function and causes night blindness. Vitamin C deficiency hinders the body’s endogenous antioxidant systems, reducing its ability to combat oxidative stress. Vitamin D deficiency, which afflicts U.S. adults and teens at shockingly high rates, impairs immunity and increases the risks of osteoporosis, autoimmune disease, metabolic syndrome, and diabetes. When we consider the prevalence of nutrient deficiencies and their health consequences, it becomes evident that the epidemic of “overfed but undernourished” may be a critical contributing factor in the chronic disease epidemic we currently face here in the United States. The million-dollar question is, why are Americans so depleted in nutrients despite having a high calorie intake? The answer lies with the nutrient-poor, processed diet consumed by most Americans, soils that have been drained of their nutrients by intensive agriculture, and the rising prevalence of chronic health conditions that influence nutrient needs.

The Standard American Diet Is a Nutritional Travesty

In parts of the developed world such as the United States, our diets are calorie dense but not nutrient dense. Furthermore, the more calorie-dense, nutrient-poor foods one consumes, the higher one’s risk of becoming nutrient deficient. Considering that more than half the calories Americans consume come from nutrient-depleted, ultra-processed foods, including refined flours and industrial seed oils, it comes as no surprise that so many people are undernourished. (7) To make matters worse, fruits, vegetables, meat, and dairy provide a much smaller share of the average American’s daily calorie intake today than they did four decades ago. This is a shame because these foods happen to be some of the most nutrient-dense options available. (8)

Unhealthy Soils Produce Nutrient-Poor Foods

Modern intensive agricultural methods harm our health not only by exposing us to ever-increasing levels of pesticides, but also by stripping nutrients from the soil in which our food grows. This results in food with lower levels of micronutrients. In addition, as crop yields have increased with the rise of intensive agriculture, a “dilution effect” has taken place, further lowering the average concentrations of minerals in crops. (9) For example, studies conducted in the United States and the United Kingdom indicate that cultivated vegetables and fruits have experienced median declines of five to 40 percent in protein, calcium, phosphorus, riboflavin, and vitamin C content between 1950 and 1999. (10) These findings suggest that relying entirely on food for our micronutrient intake may result in a failure to meet our nutritional needs.

However, this doesn’t mean your clients and patients should give up on fruits and vegetables altogether and rush to the store to grab a multivitamin! While dietary supplements have their place, our clients should first focus on bolstering their nutrient levels by sourcing and consuming as many nutrient-dense foods as possible. Organ meats, eggs, grass-fed beef, fermented foods, and pastured dairy products are some of the most nutrient-dense foods available and should be a regular part of your clients’ diets. Choosing to eat organically grown foods is another way to achieve a higher dietary micronutrient intake because studies have found that by promoting healthier soil, organic farming boosts levels of key nutrients in fruits, vegetables, and dairy products. (11, 12)

Chronic Disease and Toxic Exposures Influence Nutrient Status

Gut microbes have a significant influence on nutrient status because they facilitate nutrient absorption from ingested food within the digestive tract. Research indicates that an altered gut microbiota compromises nutrient absorption and promotes deficiencies of key nutrients such as vitamins A, D, E, K, and B12, as well as iron. (13) Many chronic diseases are associated with alterations in the gut microbiota, so the epidemic of chronic disease afflicting the United States and associated changes in the gut microbiome may be one reason Americans are experiencing such high rates of malnutrition. (14) However, by correcting the underlying causes of chronic diseases and restoring balance to the microbiome, it may be possible to resolve nutrient deficiencies.

Increasing exposure to environmental toxins contributes to undernourishment. Heavy metals such as lead, arsenic, cadmium, and mercury interrupt the absorption, metabolism, and utilization of essential minerals; over time, this may lead to deficiencies of calcium, iron, and zinc. Avoiding heavy metal exposure and ensuring optimal intake of essential minerals can help displace heavy metals from the body and resolve mineral deficiencies.

Finally, food allergies and intolerances may necessitate the avoidance of foods that contain essential nutrients and promote nutrient deficiencies. For instance, a dairy intolerance that requires a patient to avoid dairy products entirely may result in a low intake of calcium. In these situations, clinicians need to help their clients find nutrient-dense foods that they can tolerate and that will satisfy their nutrient needs, or offer appropriate supplementation to fill in the nutritional gaps.

How to Maximize Nutrient Intake

There are several steps you can take to help your clients and patients maximize their nutrient intake and avoid the pitfalls of nutrient deficiency:

  • Advise your clients and patients to eat a nutrient-dense, whole-foods diet. The average Paleo diet provides nutrients well in excess of the RDA. The only exception to this rule may be calcium, for those who cannot tolerate dairy products. In this case, bone-in fish, dark leafy greens, almonds, and sesame seeds can be used to provide a sufficient calcium intake.
  • Encourage safe sun exposure. Obtaining adequate sun exposure is crucial for ensuring an optimal vitamin D level. Full-body exposure to the midday sun for approximately 15 minutes can produce 10,000 IU of vitamin D. Darker-skinned people may need to spend more time in the sun to achieve the same level of vitamin D production.
  • Advise your clients to consume organic fruits, vegetables, and dairy when possible. Organic foods may be more nutrient dense than their conventional counterparts.
  • Be smart about supplementation. When making nutrient recommendations to clients, clinicians need to consider many factors, including the client’s life stage, activity level, underlying health conditions, food intolerances, genetics, environment, and season. Patients’ nutrient intakes will need to be adjusted accordingly based on these factors.