Am I Getting Enough Vitamins?

A simple breakdown of how to spot the signs of deficiency and make sure your diet covers all the essentials.  

Trying to get enough nutrients can feel overwhelming. How can you be sure you are getting enough? Thankfully, the answer is more simple than you might think.

The first step in consuming enough vitamins (and minerals) is to prioritise variety in your diet. 

If you consume a varied, balanced diet, you are likely getting enough vitamins and minerals. This means not just adequate amounts of fruits, vegetables, grains, proteins, etc, but also diversifying your intake within those groups. For instance, the recommended total vegetable intake for the US is anywhere from 2-4 cups per day, and the UK is 2-3 servings a day. But within the vegetable category, there are subcategories, including dark green vegetables, red and orange vegetables, starchy vegetables, legumes, and others. This is because different vegetables offer different vitamins, minerals, macronutrients, and phytonutrients. 

In addition to your food intake, other tools can help you get enough vitamins and minerals, like fortified foods and supplements. Fortified foods are any foods that have vitamins and minerals added to them to boost their nutritional value. This process has historically been very successful in preventing deficiencies. 

What are the nutrients people are most likely underconsuming?

“Shortfall nutrients” are vitamins and minerals that most people don’t get enough of. The main ones include vitamin A, vitamin D, vitamin E, vitamin C, folate, calcium, magnesium, and potassium.

Nutrient deficiency vs nutrient inadequacy; what's the difference? 

• Micronutrient deficiencies: A deficiency happens when you don’t get (or don’t absorb) enough of a certain nutrient — low enough that it can actually cause a deficiency disease. Deficiencies in certain vitamins and minerals result in specific symptoms. For example, a vitamin A deficiency can lead to night blindness.

• Nutrient inadequacy: This is when you’re getting more than the bare minimum to avoid a deficiency, but still not enough to meet your body’s needs. More specifically, it’s when your intake falls below the Estimated Average Requirement (EAR) — the amount that would meet the needs of about half of healthy people in your age and gender group. 

Nutrient inadequacy is common in Western diets, and generally more common than deficiencies. Several factors can contribute, including increased nutrient needs, poor diet quality, greater metabolic losses, medical conditions, or decreased digestion and absorption. Symptoms of nutrient inadequacy are a bit more general than the symptoms of deficiencies and can include general fatigue, reduced ability to fight infection, and impaired cognitive function.

How do you know if you have a deficiency?  

Some nutrient deficiencies are best diagnosed through blood tests. Blood work can show the serum/plasma levels of biomarkers, which help us figure out whether you’re absorbing and getting enough of a particular nutrient. 

For example, vitamin D is commonly checked by looking at a biomarker called “Serum 25-hydroxy Vitamin D [25(OH)D]”. Your healthcare provider will check whether your levels fall within an acceptable range. If they’re too low, that’s considered a deficiency. 

Not every nutrient is as easy to diagnose through blood tests, though. Take calcium, for example — it’s most abundant mineral in the body, but blood calcium levels don’t always tell the full story. This is because serum calcium does not fluctuate with changes in calcium consumption; low calcium biomarkers do not necessarily reflect low calcium intake. Having normal serum calcium levels does not reflect nutrition stores because the body can deplete the calcium from stored in our bones in order to keep our serum calcium levels in a normal range. 

[TL;DR: Your body works hard to keep blood calcium levels steady, even if it means pulling calcium from your bones. That means you could have normal blood levels while still having low calcium stores.]

In this scenario, the best way to assess calcium status would be by looking at your diet instead. 

Dietitians can do this by conducting dietary surveys for the patient and then comparing their average intake with the recommended intake levels. 

Common shortfall nutrients and signs of deficiency:

• Vitamin A deficiency: Rough skin (keratosis pilaris), night blindness

• Vitamin D deficiency: Low serum calcium and phosphate, muscle weakness, osteoporosis

• Vitamin E deficiency: Peripheral nerve damage, ataxia (loss of coordination), retinopathy (disease in the retina, a part of the eye)

• Vitamin C deficiency: Dry & damaged skin, spoon-shaped fingernails, slowly healing wounds, bleeding gums

• Folate: Fatigue, mouth sores, neurological issues

• Calcium: Numbness in fingers, muscle cramps, osteoporosis (weak bones)

• Magnesium: nausea, fatigue, weakness, vomiting 

• Potassium: Increased blood pressure, increased bone turnover, hypokalemia (low potassium levels)

Who might need to take supplements?

For anyone who’s been diagnosed with a deficiency by their healthcare provider, specific amounts of vitamins and minerals will be recommended to correct it.

There are also certain factors that make people more likely to need support from a supplement or multivitamin for their nutrient intake. This includes age, certain medical conditions, being pregnant, or breastfeeding.

If you are having trouble meeting your nutrient needs, try a food-first approach, and use supplements to fill gaps where necessary.