Processed foods, mineral-depleted soil, overcooked vegetables, increased stress levels -- all of these increase the chances of having a vitamin deficiency, according to a vocal majority of 番茄社区 readers who commented on last week's poll.
We asked readers if and when patients should be assessed for vitamin deficiencies. Of the more than 2,200 votes, 69% said that patients' vitamin levels should be assessed at least annually.
"I cannot remember how many patients have been rescued from dementia and psychosis by B12, especially when I have a geriatric focus," said one doctor, who also touted vitamin D, calcium, fish oil, and thyroid testing. "Everybody deserves a look about once a year."
But once a year was not enough for some (9% said every visit) and too much for others. One cardiologist said he or she tests vitamin levels every six months with a "pick up rate over 25%." Another commenter said that yearly testing seems too frequent. "Getting a baseline every five years with additional testing as needed seems better."
We received several anecdotal accounts about vitamin deficiency being caught, but only when the patient requested the test.
"I was diagnosed with severe insufficiency of vitamin D and only had it tested because I requested it," said one woman, who added that her mother and daughter were subsequently found to be vitamin D-deficient.
"I have just been rescued from severely low vitamin D levels, and my daughter has been found to have low vitamin levels as well. I wish my doctors had been checking levels all along," noted another 番茄社区 reader.
And another expressed similar exasperation. "It was not until I was diagnosed with osteoporosis that I had a vitamin D 25-OH test, and found out that despite being outside every day, my level was insufficient. By then it was too late. I am very disappointed that my physician did not order this inexpensive test years ago. Now, I have asked for a B12 test as well."
One woman's B12 deficiency mimicked multiple sclerosis and she went through a battery of tests before a neurologist ordered vitamin testing for her.
"It baffles me that insurance companies aren't pushing for annual vitamin testing, because so many conditions can be resolved with proper vitamin supplementation," wrote one woman, who also was found deficient in vitamin D after she requested the test.
The comments also parsed the meaning of "recommended daily allowance" (RDA). Most agreed that the RDA is not meant to prevent disease states but more to support optimum health.
"The original purpose of RDAs was to specify the amounts of various micronutrients needed by the 'average' person to guard against deficiency disease; the fact that a person does not have scurvy or anemia doesn't mean she/he is getting enough vitamin C or B12, respectively, to be as healthy as possible," wrote one commenter.
But what is the root cause of vitamin deficiency? "We need to start with nutrition," was how one physician simply put it.
Others, as well, chimed in with the notion that vitamin deficiencies and chronic diseases are symptoms of malnourishment, which is symptomatic of poor eating habits.
As expressed by one European, "Ultimately, there is simply no substitute for a healthy diet. Sadly, American diets often lean toward processed foods, which tend to be low in nearly every (micro)nutrient other than sodium."
"Healthy eating is almost nonexistent today," said another commenter. "Processed and modified foods simply are not as nutrient-dense as their counterparts were perhaps 20 years ago."
And, as usual, we had at least one post worthy of going in the X-file.
"I wonder how much this 'concern' is being driven by yet more EU 'directives' banning the sale of 'natural' additives and supplements," this commenter wrote. "Whilst the profession should remain wary of too close an 'association' with what is considered as 'Big Pharma,' we should also remain acutely aware of signs and symptoms of deficiencies which have been known and recognized for centuries. The prescribing decisions must always be made as a result of knowledge, not some bureaucratic nonsense from an invisible and unaccountable back-room mandarin with several bees in his bonnet and 'fees' to be earned!"