Nutrient Depletion Despite Super-Supplementation
Very often, I encounter patients who have modified their diets, are taking high quality and appropriate supplements and nutrients, yet still are not experiencing expected improvements. Sometimes they are already on these programs when they show up to my office, yet sometimes they are established patients that have not achieved desired result from treatments. Is the answer that they are taking the WRONG supplements and nutrients? Maybe. Is it possible that they are taking low quality, minimally absorbable supplements? Perhaps. Is it possible that there is something else causing their symptoms? Possibly. However, perhaps they are taking the right type of supplements and treatment plan, the diagnosis is correct, but something else going on….
The Problem of Absorption
In order to have a therapeutic effect, nutrients need to be adequately absorbed and delivered to the cell. Even with the very best, highest quality, most expensive supplements there are issues that prevent adequate absorption nutrients derived through oral supplementation and foods. For some people, these issues can be corrected over time with natural medicine, yet for others, malabsorption may be a long-term condition.
Many factors are needed to elicit optimal absorption and delivery of nutrients, including:
- Optimal gastrointestinal health: when nutrients are taken orally, the gastrointestinal track needs to break down foods and supplements to release the core nutrients, and transport those nutrients to the blood for delivery to the cells requiring them. This requires many steps and is dependent on numerous variables to be intact, including optimal enzyme activity, proper acid production, healthy gut flora, healthy gastrointestinal lining free of inflammation and irritation, absence of “bad” bacteria, healthy parastaltic tone (pumping action of the GI tract), as others.
- Healthy liver function: after the nutrients are transported to the blood, they are then delivered to the liver for filtering and detoxification before having opportunity to reach other cells in the body. This is referred to as “first pass metabolism.” A compromised liver can make certain nutrients inactive, ineffective, or bound for excretion before given the opportunity to have their effect in the body.
- Healthy cell membranes: cell membranes contain energy requiring pumps to maintain proper levels of essential nutrients inside the cells. Often nutrients need to be in higher concentration inside the cells compared to outside the cell. In any mixture of substance, there is a natural predisposition for solutes (aka nutrients, minerals, etc) to flow from levels of high concentration to lower concentration, which is called the “concentration gradient.” This is analogous to an overcrowded train. People in the overcrowded train will tend to move to an empty train if one is available, so there is more space to breath. However, it would take a little force to squeeze in additional people into an over packed train, requiring some shoving and pushing to make room. Similarly, in order to keep higher levels of nutrients inside the cell where they can do repair and healing, the cell membrane needs to be healthy, and have enough energy (ATP) to fuel the pumps to transport the nutrients from outside the cell (the empty train) to the inside of the cell (crowded train) against the “concentration gradient.” This is called “active transport”.
Most People Have Suboptimal Absorption
Nutrient, vitamin and mineral absorption from both foods and supplements are suboptimal in most people. Many essential minerals have as little as 1% absorption, and most only have 10-25% absorbed and available to the cells in healthy adults. This is often related to suboptimal functioning of the systems involved in absorption due to various causes.[i] [ii]
- Most people have some degree of gastrointestinal compromise, even when that is not their major complaint. As a naturopathic doctor, I always look to gastrointestinal health as an initial cause of disease. So many diseases and symptoms have direct correlation with gastrointestinal compromise because this leads to malabsorption of nutrients necessary to maintain health! If the body is starving for nutrition, it starts to decay and breakdown. There are numerous factors in modern society contributing to such widespread gastrointestinal dysfunction, which cannot always be avoided. Poor diet, inflammatory foods, processed foods, transfatty acids, environmental toxins (heavy metals, PCB’s, pesticides, dioxins, smog), chronic medication use, synthetic hormones, bacteria, viruses, Candida, fungus, chronic stress, and so on all engender decreased gastrointestinal health. With sub-par gastrointestinal function, is it a surprise that most people are unable to absorb nutrients requiring optimal gastrointestinal function?
- We as a society tend to ascribe to the thinking of “if it ain’t broke, don’t fix it.” As a naturopath, I hope to change this thinking to “If it ain’t broke, lets keep it that way!” Not as catchy. However, until this paradigm shift fully occurs, people tend to seek healthcare when they are already sick or starting to have symptoms. By that time there is already diminished function down to the cell itself, with decreased energy production causing compromised membrane function. To recall, membrane pumps require energy to bring in essential nutrients and transport out toxins. This becomes a Catch 22 situation: nutrient depletion and toxins lead to cellular dysfunction, decreased energy production and “disease”; this leads to impaired membrane pumps required to maintain optimal intracellular nutrient levels and export of toxins (the cellular trash); often the nutrients may be present in small concentration surrounding the cell; if the cell could take those nutrients inside the cell, they would help promote healing and repair; however, the cell may be too sick or energy depleted to fuel the pumps required to bring those nutrients in! This is why many people taking wonderful supplements and eating a whole food diet may not experience the improvements they expect. Their cells are not healthy enough to get healthy!