13.4: How “Deficiency Symptoms” Can Deceive

If we look at the long lists of deficiency symptoms, and look without real understanding of what they are and what they mean, it’s easy to be misled. And, indeed, many are fooled.

One source of deception lies in the difficulty of identifying the symptoms themselves. For they may easily be confused with other bodily signs.

As one example, cheilosis is characteristic of a deficiency of riboflavin (a B-vitamin). Look up cheilosis in a medical dictionary, and you see that it is a swelling and cracking of the lips, especially at the corners of the mouth. Unless one is medically sophisticated, one can easily be led to believe that any case of chapped lips is in fact cheilosis.

Figure 13-2: Consuming the right amount of a nutrient, using Vitamin C as an example.

Such swelling and cracking isn’t uncommon for people who have plenty of riboflavin in their diets. Taking riboflavin won’t protect the lips of the skier or the summer lifeguard.

Another common source of confusion stems from the assumption that deficiency symptoms appear in an isolated way. Knowing that sore and bleeding gums are among the signs of scurvy (vitamin C deficiency), many people assume that any gum disease, especially where there’s bleeding, shows a need for more vitamin C. The mistake is an important one, for gum disease is the leading cause of tooth loss in America.

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Gum disease resulting from poor dental hygiene is the usual and most common cause of bleeding gums.

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But bleeding gums are merely one sign of the general tendency toward hemorrhage which develops with scurvy. Wounds don’t heal well; hemorrhages under the skin and in the nose are common—often painful—scurvy signs; and there’s muscle weakness, tenderness of the extremities, susceptibility to infection, and so forth. So bleeding gums alone aren’t a sign of scurvy. And if scurvy isn’t really present, it’s irrational to believe that taking vitamin C will help one’s gums.

Sensible Tests of Deficiencies

Before a reasonable diagnosis of vitamin deficiency can be made, there are a number of factors to take into account.

Is there only a single sign of deficiency?

If there is, it may be a situation where it’s all too easy to generalize and assume, for instance, that all gum-bleeding signifies a vitamin C deficiency. On the other hand, you don’t want to dismiss individual symptoms as unimportant; some early signs of vitamin deficiency may appear in a seemingly isolated way, as with the peculiar rash of pellagra. So we must ask another question.

Is the symptom really a deficiency sign, or is it merely something similar?

The rash of pellagra is distinctive. It isn’t quite like other rashes. And telling the difference takes the eye of an expert—hard to find in the United States because the niacin deficiency which causes pellagra is now so rare here. But few of us are experts about disease symptoms. Before taking niacin for your “distinctive-looking” rashes, consider applying some other easy tests.

Do your dietary habits suggest that your vitamin intake is adequate?

In considering your bodily needs, you look to the Recommended Dietary Allowances (RDAs). But you must remember that there are safety margins built into these recommendations. Your intake can fall below the recommendations without your having an actual nutritional deficiency. Small departures from the RDAs are unlikely to cause trouble. But the further you fall below your RDAs, the more likely you are to be deficient.

What of the idea that some people have some special high needs for vitamins? Contrary to the fear-talk of vitamin enthusiasts, these special needs are largely taken into account in setting the RDAs. The RDAs aren’t minimal; they go beyond actual requirements in attempting to assure ample nutrition for all but a very few. The Food and Nutrition Board attempts to cover 97.5% (2 standard deviations above the average) of the U.S. population with its recommended amounts. They even anticipate the need for protection against life’s stresses.

Let’s go back to the example of the bleeding gums. What do you eat that would supply your needs for vitamin C? Perhaps you detest citrus fruits and their juices, often cited as the important common sources of vitamin C.

What have we learned? Very little. Some C is included in most plant-source foods, especially in potatoes, strawberries, and green leafy vegetables. And vitamin C is added to many foods, from fruit-flavored drinks to breakfast cereal. So unless your diet is quite bizarre, a vitamin C deficiency is unlikely.

Do special stresses or other exceptional requirements spell deficiency?

Not likely, except in rare cases. For example, there’s a common misconception that a smoker needs extremely large doses of vitamin C. But the fact is that while smoking can increase vitamin C needs, it’s only by 20 to 40%. And this increased need is accounted for by a special vitamin C RDA for smokers (an additional 35 mg), making it 110 mg for women, and 125 mg for men.

How long have the symptoms persisted, and how fast are symptoms triggered?

True deficiencies are slow to develop and even slower to produce overt symptoms. It’s true that the RDAs are daily allowances. But, in reality, the recommended amounts are for averages per day, since diets vary day to day. And the amounts allow enough to maintain reserves in the body—reserves even for the water-soluble vitamins, which the body can store to some extent.

Stores of water-soluble vitamins don’t accumulate beyond a certain limit, so it’s a common misconception that they need to be consumed daily to prevent a deficiency. Practically speaking, it’s generally advised that nutrient intakes will be adequate if, over a period of a several days, they average the recommended amounts. But even failure here doesn’t necessarily mean disease.

The fact is that vitamin levels in the blood are not quickly exhausted. Typically, a month or more of complete deprivation of a water-soluble vitamin is needed before the blood supply is exhausted. Several months more of deprivation is usually needed before symptoms appear. In the extreme—as is the case with vitamin B₁₂—the body can store enough for several years.

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It should be noted that the RDAs are for healthy people. Certain diseases and conditions can warrant a physician’s prescribing larger doses.

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Similarly, vitamin deficiencies are not relieved as quickly as many believe. For example, much popular belief about alcohol and B-vitamins is unrealistic. It’s true that alcohol intake can require some extra B-vitamins. And it’s true that alcoholics tend to take in less B-vitamins when they replace many of their food calories with alcohol calories. (And it’s also true that some alcoholics suffer from severe thiamin deficiencies that can result in psychosis.)

But it’s not true that taking vitamins the morning after will counter the effects of the night before. A hangover isn’t a vitamin-deficiency symptom—a true vitamin deficiency can’t possibly occur so fast. So despite fake claims and fond hopes, vitamins won’t cure a hangover.

While some organ systems tend to be more vulnerable to vitamin deficiencies than others, a deficiency is a total body problem. Though clear symptoms may develop earlier in some organs or parts of organs than they do in others, the shortage is widespread, which chemical testing can confirm. The significant status is that of the body as a whole, even though some organs may show problems sooner than others.

To put it simply, if one has a deficiency of a vitamin, all the chemical systems which depend on that vitamin will be affected, not just one.

But in times of vitamin shortage, the body often protects the most vital organs and functions, shorting the least essential organs first. This is thought to be why the first signs of deficiency are often shown in the skin and the last in vital internal organs. This is certainly the case with niacin deficiency, in which rashes and other skin problems appear first, and effects on the brain and nerves are experienced only in the final phases.