Factors Contributing to Nutritional Deficiencies

From R. C. Schafer, DC, PhD, FICC's best-selling book:

“Symptomatology and Differential Diagnosis”

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   1.   General Factors Involved in Vitamin and Mineral Deficiencies   

Several general factors are involved in vitamin and mineral deficiencies. For example, abnormal loss and utilization or subnormal absorption, intake, storage, or transport, singularly or in combination, may readily lead to symptoms of nutritional deficiency.

See Table A.1.

     Table A.1.   General Factors Involved in Vitamin and Mineral Deficiencies
Process          Primary Suspect Disorders                       
Decreased        Congenital biliary      Laxatives
absorption         atresia               Mineral oil
                 Cystic fibrosis         Regional ileitis
                 Dysentery               Ulcerative colitis
                 Intestinal cancer              

Decreased        Anorexia                Mouth/neck trauma
intake           Coma                    Oral/denture problems
                 Dysphagia               Starvation

Increased        Alcoholism              Polyuria (eg, diabetes)
loss             Dialysis                Sweating (chronic)
                 Diarrhea (chronic)      Tobacco
                 Hemorrhage              Vomiting (chronic)

Increased        Cancer                  Liver disease
utilization      Cardiac disease         Pregnancy
                 Diabetes                Pulmonary disease
                 Hyperthyroidism         Pyrexia
                 Kidney disease          Alcohol use

   2.   Agents Contributing to Vitamin, Mineral, and Other Nutrient Deficiency Symptoms   

Drugs and nutrients often have adverse interactions. Drugs usually interfere with normal cellular nutrition by:

(1) depressing the central appetite center,
(2) decreasing normal blood levels (eg, excessive excretion),
(3) interfering with the nutrient's storage or metabolism,
(4) developing a chemical antagonism (eg, inactivate),
(5) increasing the action of ingested antivitamins or antiminerals, or
(6) destroying intestinal bacteria necessary to synthesize the nutrient.

See Tables A.2, A.3, and A.4.

     Table A.2.   Agents Contributing to Vitamin Deficiency Symptoms
Deficiency        Antivitamin Factors                                         
A                 Alcohol                        Iron (excessive)
                  Aluminum-containing antacids   Kanamycin
                  Calcium carbonate              Magnesium-containing antacids
                  Cholestyramine (Questran)      Mineral oil
                  Coffee                         Neomycin
                  Colestipol HCL (Colestid)      Paromomycin
                  Cortisone                      Vitamin D deficiency

  B Complex       Alcohol                        Sleeping pills
                  Coffee                         Stress (abnormal)
                  Diuretics                      Sugar (excessive)
                  Infections                     Sulfa drugs

  B-1             Oral contraceptives
  Thiamine        Alcohol                        Pyrexia
                  Antacids                       Stress (abnormal)
                  Clams (raw)                    Sugar (excessive)
                  Coffee                         Tobacco
                  Cyclophosphamide (Cytoxan)     Trauma/surgery (severe)
                  Diuretic drugs

  B-2             Alcohol                        Phenothiazines
  Riboflavin      Antibiotics                    Sugar (excessive)
                  Chlorpromazine HCL             Tobacco
                  Coffee                         Tranquilizers
                  Diuretic drugs

  B-6             Alcohol                        Isoniazide (INH, Nydrazid)
  Pyridoxine      Coffee                         Oral contraceptives
                  Cortisone                      Para-aminosalicylic acid
                  Cycloserine (Seromycin)        Penicillamine (Cuprimine)
                  Diuretic drugs                 Radiation
                  Ethionamide                    Tetracyclines
                  Hydralazine HCL (Apresoline)   Tobacco

  B-12            Alcohol                        Methotrexate
  Cobalamin       Barbituates                    Methotrexate (Folex, Mexate)
                  Chloramphenicol                Neomycin
                  Cholestyramine                 Oral contraceptives
                  Coffee                         Para-aminosalicylic acid
                  Colchicine                     Paromomycin
                  Diuretic drugs                 Potassium chloride
                  Kanamycin                      Tetracyclines
                  Laxatives                      Tobacco

  B-15            Alcohol                        Diuretic drugs
  Pangamic        Coffee

  Biotin          Alcohol                        Diuretic drugs
                  Antibiotics                    Egg white (raw)

  Choline         Alcohol                        Diuretics
                  Coffee                         Sugar (excessive)

  Folic           Alcohol                        Neomycin
  acid            Antacids                       Nitrofurantoin
                  Anticonvulsants                Oral contraceptives
                  Aspirin                        Paromomycin
                  Chlordiazepoxide HCL           Phenobarbitol
                  Cholestyramine (Questran)      Phyenytoin sodium (Dilantin)
                  Coffee                         Pyrimethamine
                  Colestipol HCL (Colestid)      Salicylates
                  Diazepam (Valium)              Stress (abnormal)
                  Diuretic drugs                 Sulfasalazine
                  Indomethacin                   Tobacco
                  Kanamycin                      Triamterene (Dyrenium)
                  Lorazepam (Ativan)             Trimethroprim
                  Methotrexate (Folex, Mexate)

  Inositol        Alcohol                        Diuretic drugs
                  Coffee                         Tea

  Niacin          Alcohol                        Isoniazid
  (Nicotinic      Antibiotics                    Rifampin-isoniazid
   acid)          Coffee                         Starches (excessive)
                  Corn                           Sugar (excessive)
                  Diuretic drugs

  Pantothenic     Alcohol                        Diuretic drugs
  acid            Coffee                         Tetracyclines

  Para-           Alcohol                        Diuretics
  aminoben-       Coffee                         Sulfa drugs
  zoic acid

C                 Antibiotics                    Oral contraceptives
  Ascorbic        Aspirin                        Pyrexia
  acid            Barbituates                    Stress (abnormal)
                  Cortisone                      Sulfasalazine
                  Diuretic drugs                 Tea
                  Indomethacin                   Tobacco

D                 Antacids                       Kanamycin
                  Anticonvulsants                Lorazepam (Ativan)
                  Barbituates                    Mineral oil
                  Chlordiazepoxide HCL           Neomycin
                  Cholestyramine (Questran)      Paromomycin
                  Colestipol HCL (Colestid)      Phenobarbital
                  Diazepam (Valium)              Phyenytoin sodium (Dilantin)
                  Diuretic drugs                 Primidone (Mysoline)
                  Glutethimide (Doriden)         Rifampin (Rifadin)

E                 Chlorine                       Oral contraceptives
  Tocopherol      Iron                           Rancid fats and oils
                  Mineral oil

  Unsaturated     Radiation
  fatty acids

K                 Antibiotics (prolonged)        Mineral oil
  Menadione       Aspirin                        Neomycin
                  Barbituates                    Para-aminosalicylic acid
                  Chlordiazepoxide HCL           Paromomycin
                  Cholestyramine (Questran)      Phenobarbitol
                  Colestipol HCL (Colestid)      Phyenytoin sodium (Dilantin)
                  Coumarin                       Primidone
                  Diazepam (Valium)              Radiation
                  Indandione derivatives         Rancid fats and oils
                  Kanamycin                      Tetracyclines
                  Lorazepam (Ativan)

P                 Antibiotics                    Oral contraceptives
  Bioflav-        Aspirin                        Prolonged fever
  onoids          Barbituates                    Stress (abnormal)
                  Cortisone                      Tobacco
                  Diuretic drugs

     Table A.3.   Agents Contributing to Mineral Deficiency Symptoms
Deficiency     Antimineral Factors                                   
Calcium        Actinomycin D                  Mithramycin
               Amikacin                       Neomycin
               Barbituates                    Paromomycin
               Capreomycin                    Phyenytoin
               Cholortetracycline             Plicamycin (Mithracin)
               Dactinomycin (Cosmegen)        Stress (abnormal)
               Furosemide (Lasix)             Tetracycline
               Gentamycin                     Thiazides
               Kanamycin                      Tobramycin
               Lack of exercise               Viomycin

Copper         Ethanbutol                     Zinc (large intake)

Iodine         Thiazides

Iron           Aspirin                        Paromomycin
               Chloramphenicol                Phosphorus (excessive)
               Coffee                         Prednisone
               Glucocorticoids                Sulfasalazine
               Indomethacin                   Tea
               Kanamycin                      Tetracyclines
               Neomycin                       Zinc (excessive)

Magnesium      Cortisone

Manganese      Calcium (excessive)            Thiazides
               Phosphorus (excessive)

Phosphorus     Alcohol                        Gentamycin
               Aluminum                       Iron (excessive)
               Amikacin                       Magnesium (excessive)
               Amphotericin                   Sugar (excessive)
               Calcium-containing antacids    Tobramycin
               Capreomycin                    Viomycin

Potassium      Alcohol                        Neomycin
               Amikacin                       Para-aminosalicylic acid
               Amphotericin                   Paromomycin
               Coffee                         Salt (excessive)
               Cortisone                      Stress (abnormal)
               Diuretic drugs                 Sugar (excessive)
               Furosemide (Lasix)             Thiazides
               Gentamycin                     Tobramycin
               Kanamycin                      Viomycin

Sodium         Aluminum-containing antacids   Magnesium-containing antacids
               Chlorine deficiency            Neomycin
               Ethacrynic acid                Paromomycin
               Kanamycin                      Potassium deficiency

Zinc           Alcohol                        Phosphorus deficiency
               Calcium (excessive)            Tetracyclines
               Cortisone                      Thiazides

     Table A.4.   Agents Contributing to Miscellaneous Nutrient Deficiencies
Nutrients        Antinutrient Factors                                        
Amino acids      Kanamycin                       Paromomycin
                 Neomycin                        Trimethroprim

Carotene         Methotrexate (Folex, Mexate)

Cholesterol      Methotrexate (Folex, Mexate)

Lipids           Cyclophosphamide (Cytoxan)      Neomycin
                 Kanamycin                       Paromomycin
                 Methotrexate (Folex, Mexate)

Sugars           Ampicillin                      Lincomycin
 (glucose,       Chloramphenicol                 Methotrexate (Folex, Mexate)
  lactose,       Clofibrate                      Neomycin
  xylose)        Digitalis                       Para-aminosalicylic acid
                 Kanamycin                       Paromomycin
Some adverse nondrug factors include abnormal stress, aluminum cookware, diuretic beverages (eg, coffee, ethanol, tea), excessive sugar/starch intake, lack of exercise, laxatives, prolonged fever, radiation, tobacco, and severe surgery or trauma.

   3.   Disease States Contributing to Specific Nutritional Deficiencies   

Any prolonged state of disease increases normal nutritional needs. However, certain disorders have been shown to have a particularly adverse effect on specific deficiencies.

See Table A.5.

     Table A.5.   Abnormal States Caused by or Contributing to Specific Deficiencies
Disorder                  Deficiency State                                            
Acne                      A, B425, D, niacin, potassium
Aging, premature          C, calcium, E, pangamic acid
Alcoholism                A, B-complex, C, D, iron, magnesium, thiamine, zinc
Allergies                 A, B4125, C, D, E, F, manganese, pantothenic acid
Anemia                    B-complex, copper, iron
Arthritis                 A, B425, B4125, C, calcium, D, E, pantothenic acid, sulfur
Asthma, bronchial         A, B4125, F, manganese, P, pangamic acid
Atherosclerosis           B465, C, choline, E, folate, inositol, pangamic acid, zinc
Athletes foot             A, B42
Baldness, nongenetic      B-complex, C, copper, E, F, iodine, zinc
Barbituate toxicosis      B-complex
Beriberi                  Thiamine
Biliary atresia           Fat-soluble vitamins, especially E
Biliary cirrhosis         Copper
Bleeding gums             C, P
Bone loss                 Calcium
Bronchitis                A
Bruising, easy            K
Burns                     E, para-aminobenzoic acid, potassium
Bursitis                  B412
Cancer (certain forms)    A, B-complex, C, protein
Cardiovascular disease    A, B-complex, C, E, F, magnesium, potassium
Cataracts                 B42
Cholesteremia             B465, C, choline, E, F, inositol, magnesium, pangamic acid
Colds                     A, C, P
Colic, infantile          Potassium
Colitis                   Iron
Constipation              B415, choline, inositol
Cyanide toxicosis         Folic acid
Cystic fibrosis           Fat-soluble vitamins, especially E
Cystitis                  A, B465, C, D, E, pantothenic acid
Dehydration               Sodium
Depression                Magnesium
Dermatitis                Biotin, sulfur
Diabetes                  A, B415, B425, chromium, manganese, phosphate, potassium
Diarrheal disorders       B415, B425, fat-soluble vitamins, folic acid, niacin
Dizziness                 Choline, P
Dry skin                  Para-aminobenzoic acid
Dyspnea                   Pangamic acid
Eczema                    A, biotin, D, F, P, sulfur
Emphysema                 Pangamic acid
Epilepsy                  B412
Eye hemorrhages           K
Facial oiliness           B46
Fatigue, severe           B4125, folic acid, manganese
Febrile illnesses         B-complex, C, protein
Gallbladder disorders     F
Gallstones                K
Goiter                    Iodine
Graying hair              Para-aminobenzoic acid
Growth retardation        Phosphorus
Halitosis                 Niacin
Headaches                 Choline, pangamic acid
Heat stroke               Sodium
Hemochromatosis           Iron
Hemorrhoids               P
Hemosiderosis             Iron
Hepatitis                 A, C
Herpes                    B412
Hyperkinesis              B-complex
Hyperlipidemia            Niacin
Hypertension              Choline, niacin, P, potassium
Hyperthyroidism           B-complex, iodine, para-aminobenzoic acid, potassium
Hypoglycemia              B-complex, C, chromium
Indigestion               B415, B425, pantothenic acid
Infertility               Para-aminobenzoic acid, zinc
Insect stings             C
Insomnia                  B4125, calcium, choline, niacin, pangamic acid
Kidney disease            B-complex, calcium, D, iron, magnesium, potassium, zinc
Kidney stones             Magnesium
Leg cramps                Biotin, calcium, niacin
Leg ulcers                F
Liver disease             A, B-complex, copper, D, iron, K, protein, zinc
Malabsorption syndrome    Fat-soluble vitamins, potassium
Meniere's syndrome        B-complex
Menopause syndrome        E
Menstrual syndromes       B-complex, calcium, E, iron, K
Mental illness            B415, B46
Migraine                  A, B-complex, E
Miliaria                  C
Myopathy                  B46
Myopia                    E
Nausea                    B415, B46
Nervousness               Calcium, magnesium
Neuropathy                B46
Nitrate toxicosis         Folic acid
Nitrous oxide toxicosis   Folic acid
Noise sensitivity         Magnesium
Obesity                   A, B-complex, C, calcium, E, F, magnesium
Parasitic disease         Para-aminobenzoic acid
Pellagra                  Niacin
Peptic ulcers             Magnesium, P
Pernicious anemia         B4125 
Phlebitis                 E
Premenstrual tension      B465, calcium, E, K
Prostate problems         Magnesium, zinc
Psoriasis                 D, F, sulfur
Pulmonary disease         B-complex, C
Rheumatic fever           P, para-aminobenzoic acid
Rheumatism                Calcium, P, pangamic acid
Rheumatoid arthritis      F
Scurvy                    C
Sinusitis                 C, E
Smoking toxicosis         Beta-carotene, C, folic acid
Stress (abnormal)         A, B-complex, C, D, E, phosphorus
Subacute encephalopathy   Thiamine
Sun sensitivity           B465, para-aminobenzoic acid
Tachycardia               B41
Tinnitus                  Choline
Tooth decay               C, magnesium, niacin, pantothenic acid, phosphorus
Tremors, finger           Calcium
Warts                     E
Weight loss               F
Wilson's disease          Copper
Wrinkles                  E, para-aminobenzoic acid

   4.   Effects of Some Nutrients on Certain Medications   

Just as certain medications and dietary substances have an adverse effect on certain nutritional substances, some nutrients (especially in excessive amounts) have an adverse effect on certain medications a particular patient may be taking. Thus, it is important that such medications be noted during the case history process. Because these nutrients may counteract or inhibit the absorption or utilization of various medications, conditions being treated medically may be exacerbated.

See Table A.6.

     Table A.6.   Effects of Some Nutrients on Certain Medications
Nutrient              Antagonistic to:                                          
C                     Methyldopa, oral contraceptives (greater than 1000 mg/day)
Calcium               Tetracyclines
E                     Oral coagulants
Folic acid            Anticonvulsants, fluorouracil, levodopa, methotrexate
Iron                  Tetracyclines
K                     Anticoagulants
Magnesium             Tetracyclines
Pyridoxine (B465)     Levodopa, penicillamine
Zinc                  Tetracyclines

   5.   Symptoms of Hypervitamin Toxicosis   

It has been long recognized that excessive amounts of vitamins A and D can lead to toxicosis. In recent years, adverse effects have also been shown to be contributed to megadoses of vitamins C and E.

See Table A.7.

     Table A.7.   Symptoms of Hypervitamin Toxicosis
Vitamin   Levels           Manifestations                                   
  A       Adults:          Anorexia                   Gastrointestinal dis-
           50,000+ IU/d    Behavioral changes          tress
          Infants:         Bone pain                  Hair loss
           20,000+ IU/d    Cerebral edema             Headaches
                           Depression                 Malaise
                           Dry/scaly skin             Schizophrenia
                           Fatigue                    Spontaneous fractures
  C       Adults:          Decreased beta-carotene    Infantile mega-C level
           4+ g/d           utilization (possible)     dependency
                           Decreased cysteine         Intestinal colic
                           Diarrhea                   Iron overload (possible)
                           Hypercalcemia (possible)   Low leukocyte activity
                           Increased cadimium ab-      (possible)
                            sorption                  Nausea
                           Increased copper ab-       Rectal bleeding
                            sorption                  Urinary tract calculi
  D       Adults:          Anorexia                   Kidney stones
           50,000+ IU/d    Arrhythmia                 Muscular hypotonia
          Infants:         Bradycardia                Polydipsia
           3,000+ IU/d     Constipation               Polyuria
                           Hypercalcemia              Vomiting
                           Kidney calcification          
  E       Adults:          Blurred vision (hypo-      Low leukocyte activity
           2,000+ IU/d      vitaminosis A)            Myopathy
                           Diarrhea                   Nausea
                           Fatigue (extreme)          Pulmonary embolism
                           Gonadal dysfunction        Purpura (hypovitamino-
                           Gynecomastia                sis K)
                           Hypertension               Rash
                           Intestinal colic           Thrombophlebitis
  E       + Oral           Increased serum choles-    Increased serum trigly-
         contraceptives     terol                      cerides
Niacin   Adults:           Hypertension               Liver damage
          5+ g/d                        
Pyri-    Adults:           Injury to dorsal roots of spinal cord
doxine    500+ mg/d

Nutritional or ingested environment minerals may also lead to toxicosis.

Toxicity levels have already been established for:
copper (40 mg),
iron (100 mg),
magnesium (30,000 mg),
potassium (1.950—5.850 mg), and
sodium (2,300—6.900 mg/d).