564: Chris Kresser on Nutrient Deficiencies & Why the Way We Think About Health Needs to Change

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Katie: Hello, and welcome to the “Wellness Mama” podcast. I’m Katie from wellnessmama.com, and wellnesse.com, that’s wellnesse with an e in the end, which is my personal care line. And today, I’m here with someone I highly, highly respect and have both respected his work and been friends with for a long time, which is Chris Kresser. We go deep on the topic of nutrient deficiencies and why the way we think about health needs to change.

If you’re not already familiar with Chris, he is the co-founder of the California Center for Functional Medicine, the founder of The Kresser Institute, the host of the top-rated podcast “Revolution Health Radio,” the creator of chriskresser.com, and the “New York Times” best-selling author of the “Paleo Cure and Unconventional Medicine.”

He is by far considered one of the most respected clinicians and educators in the field of functional medicine, and he has trained over 2,000 clinicians and health coaches in over 50 countries using his unique approach. He’s been named one of the 100 most influential people in health and wellness and has appeared on alludes everything from Joe Rogan, to “Fox & Friends,” to many other national media outlets. In this episode, we go deep on the topic of “Nutrient Deficiencies and Micronutrient Deficiencies,” which I think is an increasingly important topic.

I have for a long time thought that we have lost sight of this important part of the equation when we over-focused on calories or even macronutrients, because you could be eating enough food or calories or volume of food, and still drastically undereating in nutrients. And I’ve tried to shift my own perspective to actual nutrient density per volume and calorie of food that I’m consuming and not just the calories themselves, but we go deep on this and he talks about why Americans especially, are overfed but undernourished, how on average in America 60% of the calories come from ultra-processed foods, we talk about top foods to avoid, why the body needs 40 micronutrients in adequate amounts to function and why many of us are not getting these.

Things like how 100% of Americans don’t get enough potassium, and we go deeper on a lot of different specific nutrients. We talk about the ones generally considered safe to supplement even without testing, the ones you want to be a little more careful about, some of the reasons the nutrient levels and density are declining so much right now, optimal versus RDA when it comes to nutrients, specific things to know about vitamin D, vitamin A, and iron, and how specific diets like carnivore, vegan, AIP, etc., can affect nutrient levels and how to mitigate those if you are on one of those diets, the top nutrient-dense foods and some of that might surprise you.

So, he talks about fascinating new research that scores food based on nutrient density and their nutrient levels, and then his controversial statement on why it would almost be better to be a vegetarian that eats organ meat and shellfish a couple of times a week, than to just eat muscle meat with no organs or shellfish, so a very wide-ranging episode. Chris is always a wealth of knowledge, he definitely does not disappoint in this episode, I learned a lot, I always do from him. I know you will, too. So, without any further wait let’s join him. Chris Kresser, welcome. Thanks so much for being here.

Chris: Katie, it’s always a pleasure to speak with you.

Katie: I’m so glad we get to have this conversation, and record it. And we’re gonna talk about what I think is a very, very important topic, especially in today’s world, which is the topic of nutrient density, and go into things like micronutrients and some specifics within this. But as I mentioned before we even hit record, I see this more and more, especially, it seems, among women, where the conversation is often about calories or even macros, but there isn’t as much conversation about the nutrient density of food. And I do see women now, thankfully, eating more protein, or at least being aware that they need to eat things like protein. But I feel like that conversation hasn’t gotten into the nuance of nutrient density. And one thing I’ve personally tried to shift in the last couple of years is to shift my mindset away from deprivation and dieting and into, how can I maximize nutrient density per calorie, per volume of food? Anything I eat, how can I make sure I’m getting the most nutrient-dense? And I know it’s even more beyond just what we can eat, but I’d love to start there and just talk broadly about why nutrient density is so important.

Chris: Yeah. Well, Katie, you’ve heard this saying, I’m sure, “We’re overfed, but undernourished.” And I think that really encapsulates the problem, in just a few words, where we are getting more calories than we need, but 60% of those calories today in the U.S. come from ultra-processed foods. Not just processed foods, but ultra-processed foods. So, we’re talking about refined flour, sugar, industrial seed oils, and all of the highly-processed foods that make up the packaged foods that many Americans are basing their diet around these days. And the problem with that, of course, is that the body needs at least 40 micronutrients to function optimally, and if we don’t get enough of any of those nutrients, we’re gonna develop health problems, we’re gonna have a shortened lifespan, and we’re just not gonna feel well. And I think the difficulty there is that we can survive with many nutrient deficiencies.

Now, certainly, there are some nutrient deficiencies that can become so severe that they’re life-threatening and even fatal, severe Vitamin C deficiency causing scurvy, for example, which doesn’t happen very often anymore. But the insidious part of this is that even though we can survive with these nutrient deficiencies, we don’t thrive. And there’s no red light that flashes on our dashboard, so to speak, that tells us that we’re not getting enough of these nutrients. And so, many people can go for years without knowing that they’re dealing with a either suboptimal amount of a certain nutrient, or even a full-fledged deficiency, in part, because they’re generally not tested for in the conventional medical setting, and even when they are tested for, it’s very challenging to identify them, particularly in the case of some nutrients. So, it’s a really thorny problem.

Katie: Yeah. I am curious to learn more about this, because I know, just for me, personally, when I started even just tracking macronutrients, I assumed I was eating enough protein, I assumed I was eating enough calories, and realized when I actually paid attention to it and tracked that I was drastically undereating, and at one point was only getting, like, 30 grams or 40 grams of protein a day. And just making the shift and eating more protein and more calories made such a huge difference in my energy levels and so many other things, and actually helped with weight loss. But macronutrients are a thing that are easier to track. I feel like micronutrients, like you said, may have no idea if we’re deficient in some of these, but I know you’ve worked with thousands and thousands of people on this. So, how common are these nutrient deficiencies?

Chris: It’s a great question. So, if we, like, take a macro approach, and then zoom in, if we look at just general statistics of a nutrient deficiency in the U.S. population, and… I’m gonna focus on the U.S. because that’s where I live, and most of the statistics are available. But if I say U.S., you can probably assume that the rates are similar anywhere in the developed world, like the UK, Australia, Canada, etc. So, in the U.S., recent surveys suggest that most Americans don’t get enough of not just one essential micronutrient, like vitamin or a mineral, but several. So, for example, 100% of Americans don’t get enough potassium. That’s 100% of Americans. And that’s probably rounded up. Maybe there’s five people who are getting enough potassium, but, generally, you know, almost everybody is not getting enough potassium.

We have 94% not getting enough Vitamin D, 92% not getting enough choline, 89% not getting enough Vitamin E, 67% Vitamin K, 52% magnesium. And the list goes on. Now, I think it’s actually worse than that, because the numbers I just gave you are using the RDA, or the recommended dietary allowance. And the problem with using the RDA as a threshold for nutrient sufficiency is that the RDA was originally developed to understand the amount of nutrients that we need to get to avoid acute disease states. So, that’s, we’re going back to the more serious, acute problems that people can develop from nutrient deficiency. Scurvy, rickets, things like that. The RDA was never designed to be the amount of a nutrient that we need for optimal health and function, which is, of course, what we’re most interested in, you know, extended longevity, optimal health. That amount is almost certainly much higher than the RDA, for most people.

And then, even the RDAs themselves have often not been updated based on the changes in body weight, the average body weight that have occurred over the last several years. So, magnesium is a really good example of this. The original RDA for magnesium was based on…420 milligrams a day for men and 320 milligrams a day for women. But it was based on the average body weight of adults in 1997, which was 133 pounds for women and 166 pounds for men. Fast forward to today, the average body weight for a man is 196 pounds and the average body weight for a woman is 169 pounds. So, these are pretty significant increases. And when the researchers recalculated the RDAs for magnesium, based on these adjusted body weights, they found that it should be, for women, somewhere between 467 milligrams and 534 milligrams per day, and for men, between 575 milligrams and 657 milligrams per day.

What this means is that if we use these adjusted RDAs, the average American is getting 200 milligrams to 300 milligrams per day less of magnesium than they need even just to meet the RDA, which, as we said, is not necessarily the amount for optimal function. So, that gives us some idea of what the problem is on a broad scale. Now, with my patients, every single patient that I have treated over the last 15 years, we did some form of nutrient testing. So, this can be a lot of different methods, depending on the nutrient. And we can come back to the challenge of how to assess nutrient levels, because it’s a big issue, but it could involve blood testing, it could involve hair analysis, it could involve urine analysis, and in some cases, it could involve just an app like Cronometer or similar apps that you can use to very carefully measure what you’re eating, and then the app itself will estimate your nutrient intake based on that, because there are certain nutrients that are just almost impossible to test for using any body tissue, so we have to revert to the kind of old school method of just estimating based on food intake.

Now, my patients have generally been, you know, some of the most motivated and educated people in the health world, just by the nature of how they find me, listening to my podcast, and read my blog, etc. So they’re not the average, typical population. We would expect their nutrient intake to be much higher, in general, than the average population. And yet, I can only think of a few patients in the whole history of doing this kind of analysis that had completely normal nutrient intake. So, that’s the state of where we are, I think, with this issue.

Katie: Wow. And the RDA versus optimal also makes me think of how, in a lot of areas of lab testing, what’s considered normal range is also not optimal range. And I remember for so many years being told certain thyroid levels, and they were only testing a couple anyway, were “normal,” but they weren’t looking at antibodies and a lot of other things. And also, the people who get tested for thyroid problems often are already on the lower range, so the normal ranges are created from people who aren’t optimal. And this seems like a pretty widespread problem. And I love that you brought that distinction of surviving versus thriving, and actually wanting to feel optimal, because you’re right. It’s one thing to just avoid acute disease, which hopefully should be a goal, but it’s something far beyond that to actually feel our best and operate at our highest level.

And I know there’s also a difference between types of nutrients, and some that you actually can take too much and have a problematic response from, but others that we’re likely to be very, very deficient in, and that are generally considered safe to take in certain amounts. Can you talk a little bit more about that, of, like, are there some that people should just take almost as an insurance policy, because it’s so common for people to be deficient in them, and if so, what are those?

Chris: Sure. That’s a great question. Before I dive into that, I do wanna reflect what you said about the lab ranges being too broad for many nutrients, because that is a huge problem. People go to their doctor, and let’s say the doctor does run a serum B12 test, which is very rare, by the way. You pretty much have to ask for it, and even then, the answer is often no. But let’s say you do get one, and the result comes back and the value is 310. Now, the lab range for B12 goes down to 220, for most labs, as normal. But if you look in the scientific literature, you can find numerous papers showing that the effects of B12 deficiency, which, in some cases, can be lifelong and irreversible, you know, changes to DNA, and a whole bunch of other things, start to happen with B12 levels at 400.

So, even though the 310 value will be marked as normal on the lab sheet because it’s in the normal range, if the clinician who ordered that test isn’t aware of that research, and doesn’t know that that is too low, for a low end of the range, then that person will be sent away with potentially a serious B12 deficiency problem, just because of this issue with the lab ranges being far too broad. So, it is a big problem, and it’s not just with B12. It’s with so many other nutrients.

Getting back to your question, yes. I mean, there are certain nutrients, what I call nutrients of concern, where they have to be in a kind of Goldilocks range for us to be optimally healthy. Iron is a great example of that.

So, iron deficiency is a huge problem worldwide, affecting up to 2 billion people, but there’s a genetic condition called hemochromatosis, which is actually the most common genetic condition among people of North American descent, and that causes aggressive iron storage, and can lead to very high iron levels, and a condition called hemochromatosis, which can actually be fatal if it’s not detected. And it’s often not detected until it’s too late. So, that’s definitely an example.

Vitamin A is another nutrient that can be toxic at very high doses. Some of the B vitamins can be toxic, like B6, when they’re taken at too high of a dose, and cause nervous system issues. Iodine can be problematic for some people, especially people with thyroid issues, like you mentioned, Katie. On the other hand, iodine deficiency can cause hypothyroidism. And this is, in fact, the most common cause of hypothyroidism worldwide. So, those are the nutrients that have that Goldilocks range.

Vitamin D actually is another one. Most people aren’t aware that Vitamin D can have toxic effects at high levels, and so they got the public health memo that they should increase their Vitamin D levels, they started taking 10,000 IU per day, and then after 4 years, they come to see me, and I see that their level is 120. And that’s a level which could cause kidney stones and calcification of the arteries, and a bunch of other nasty things that we don’t want. And you can’t really feel that. You know, you won’t feel that. I mean, you’ll feel a kidney stone, for sure. If anyone’s ever had one, they know that, but you’re not gonna feel a calcified artery, typically. And so it’s something to watch out for.

The nutrients that almost all people are deficient, and that we talked about, of those, some of them can just be, you know, you don’t have to worry much about, like Vitamin C, for example, even at very high doses, seems to be safe. Vitamin K2, which most people don’t get enough of, and most people hadn’t even heard of until about five years ago, you know, very, very large doses, way beyond what you could get in the diet, have been used in studies, and there doesn’t seem to be an upper limit there. Vitamin B12, for most people, doesn’t seem to have an upper limit, and many people are deficient in. And then you have nutrients like magnesium and potassium, which are in more of a middle range. So, they’re less likely to cause toxicity effects than something like iron, but they still can. And if anyone’s ever taken too much magnesium, you often know what happens. You’re running to the bathroom. And same thing can happen with Vitamin C.

And then there are nutrients like calcium, where it really depends how you’re getting that nutrient. So, if you’re getting a lot of calcium from food, your body knows how to kind of regulate that and deal with it so that it’s not problematic, but if you’re taking calcium in supplement form, we’re not used to that really large bolus of calcium coming into the body all at once, and that can, you know, body can’t really deal with that, and that can cause the similar problems to excess Vitamin D, like calcification of the arteries or increased risk of kidney stones, etc.

So, I wish I could, like, boil it down into one or two simple rules, but it’s quite complicated when it comes to these nutrients, and, you know, the default that I always go to, and I know you take the same approach, Katie, is to get as many of the nutrients you can from food, because that’s the way we’ve been doing it for a really long time, and the body is adapted to getting nutrients that way, and is best able to deal with any potential downsides of too much that way. But even then, that’s not a hard and fast rule. If someone has hemochromatosis, they can get too much iron from the diet as well. You know, they can get into trouble that way. So, it’s complicated, but I think sticking, like, focusing on food as the foundation… Doesn’t mean we can always meet our nutrient needs through food. I’m sure we’ll come back to that. But focusing on that as the foundation is a really good starting point.

Katie: That was such a good explanation. And just to make sure I echo correctly. So, these are ones, especially the first few that you mentioned, that absolutely can be dangerous in high amounts, but also it’s important to remember that most people are actually deficient in them, because I’ve heard of people being afraid to take certain nutrients, or even eat certain foods, because they’re worried about toxicity, when, statistically, it’s more likely that we’re actually low in most of these than high in them, right?

Chris: That’s correct. And that’s the challenge, right? So, with iron, I mentioned 2 billion people are deficient worldwide. Iron deficiency anemia is still a major cause of death and disability around the world. It’s more common in the developing world, where people don’t have access to animal protein and high-quality sources of heme iron, but it still happens in the U.S. And, you know, it’s normal for me, very common for me, to see iron deficiency and anemia on blood panels of people that I treat here in the Western world. And so, yes, I would say iron deficiency is a much bigger problem, statistically speaking, than iron overload, which can happen pretty much almost exclusively with people that have a genetic predisposition to that. So, even though it’s a common genetic predisposition, it still only affects about 1 in 200 people in the U.S. And the rate of iron deficiency is much, much higher than that, on a per-hundred-person basis.

So, I think the bias should still be, as I think you’re alluding to, on getting more nutrients, like, getting more nutrients from food, but just, a kind of caution, I guess, I would put up there, that it’s not a bad idea to have some nutrient testing occasionally if you can. Like, if you’re taking Vitamin D, for example, to get your Vitamin D level tested once a year, and just see where you’re at. Or, sometimes you only really need to do that a couple times. Let’s say you start a higher dose of Vitamin D, you test three months later, it’s fine, then you test six months later, it’s fine. You’re probably gonna be fine. You know, you can just keep on taking that dose of Vitamin D. But because there are seasonal changes with sun exposure and other things that affect Vitamin D level, it’s just not a bad idea to just get that done once a year, so you make sure you’re in the right range.

For things like iron, it’s a little trickier, because it is not a super common condition, a lot of doctors don’t do a full iron panel. And if you’re doing fine, you don’t really have any symptoms, chances are you don’t have iron overload, but if you start to develop symptoms like fatigue, or brain fog, or sexual dysfunction, which are some of three of the top symptoms of iron overload, then that might be a good time to get a more complete blood panel done.

Katie: And to go just a little deeper on Vitamin D, I know one thing that is pretty widely talked about is, you know, there’s a lot of pressure to avoid the sun, wear sunscreen at all times. This has increased, from what I’ve seen, over the last couple of decades. And statistically, we are getting less sun exposure than we used to, and wearing more sunscreen than we used to. And, of course, the body can… That’s an important part of the Vitamin D equation.

I’m curious if you have any guidance or nuance on that, because I know many people do turn to supplemental Vitamin D because of that, because they’re trying to avoid too much sun exposure. I don’t fully understand the reason why, but I know, for me, when I was supplementing with Vitamin D, it was very difficult to get my levels to rise, and that was part of the consideration in moving to a sunny area. And now, getting adequate sun exposure, my levels stay in a really good range. But what caveats would you add to that as far as any differences between Vitamin D from sun exposure versus supplemental forms?

Chris: Yeah. That’s a great question. There are a lot of differences, and we could do a whole podcast on this topic. It’s, sadly, complex. And I say sadly because I wish I could just, you know, I think people are kind of overwhelmed already with all of the conflicting information out there. And I wish I could just boil this down and make it simple, but the truth is it’s not that simple. And, in fact, some researchers have argued for what they call an individual range of Vitamin D, which means there’s so many different factors that affect Vitamin D status, and those factors can vary so much from person to person, that it’s almost silly to talk about one range for Vitamin D that applies to everybody. So, let me give you a few examples.

One is that we know that certain health conditions decrease the absorption of Vitamin D, whether we’re getting it from food or supplements. They also decrease the conversion of sunlight from Vitamin D when it hits our skin.

So, obesity is one of those conditions. Inflammation, which is, of course, at the root of all chronic diseases, is another thing that reduces that conversion or absorption of Vitamin D. Any kind of GI issue, like SIBO, or intestinal permeability, AKA leaky gut, disrupted gut microbiome, that can reduce the absorption of Vitamin D. So, those people might consume the same amount of Vitamin D as someone else who doesn’t have that condition, or be in the sun for the same amount of time, but they’re not actually gonna absorb the same amount of Vitamin D. So, that’s a problem.

We have differences genetically and ethnically with the conversion of the less active form of Vitamin D into the more active form of Vitamin D inside of our body. So, 25-D is the form that’s typically measured on a blood test, but that’s the less active form. It needs to be converted into 1,25-D to have the full effects. And we know that some people, like, for example, people of African American descent have a really different rate of conversion of that less active form to the more active form than people of Caucasian descent. So, that’s another complicating factor. Then we have the differences in just eating or taking Vitamin D as a supplement, and producing it from sunlight hitting the skin. Those, as you can imagine, are very different mechanisms in the body, governed by a whole bunch of different processes, each of which requires different nutrients as cofactors for enzymes along those processes.

And so, you can get situations, Katie, like you had, where you’re not very efficient at absorbing Vitamin D from supplements, but you’re quite efficient at producing Vitamin D from sunshine. You can also get the other way around, where somebody can spend a lot of time in the sun, but not produce as much Vitamin D as a result of that, whereas they’re quite sensitive to Vitamin D from food or supplements. So, this is where, like, trial and error actually really makes a difference in doing what you did, like observing, “Hey, I’m taking Vitamin D. I’m testing my levels. They’re not going up. But wait, I just took a vacation, you know, to the beach, and now my levels went way up.” It’s really important to do that kind of testing and experimentation, because everyone’s gonna be different. And we don’t yet have a clear way to guess who’s… You know, we have some indicators, like race and ethnicity and health status, like I said, obesity versus being lean, but we’re not yet at the point where I can just, like, plug all those into an algorithm and give you really clear advice without doing some of that trial and error testing.

Katie: And another one I’d love to go a little deeper on is Vitamin A, because I know it’s one of the fat-soluble vitamins, and it is one that you can have too much of, but at least from what I’ve seen, this is one that the vast majority of Americans are deficient in. And I feel like it’s not well-understood. And this one also seems to have a difference between food sources and supplemental sources. And there seems to be a lot of nuance there, but, overall, it seems like we are, on average, not getting enough of this. So, can you talk about where it comes from, and how we can know if we’re getting an optimal range?

Chris: Sure. Yeah. I think the most important distinction that people need to be aware of right off the top is that Vitamin A is actually a group of compounds. So, there are carotenes, like beta-carotene, that you find in carrots and red peppers and other brightly-colored vegetables. And these carotenes are actually precursors to the active form of Vitamin A, which is retinol. And retinol, you only find in animal products. So, liver is one of the highest sources, ounce-for-ounce. And that’s true for a lot of different nutrients, which is one of the reasons we’ve both recommended it for so many years. But it’s found in other animal proteins as well, muscle meats, and a little bit in pasteurized eggs, etc. And when you look at a food label and it says Vitamin A, it’s not telling you whether that food has carotenes, which are the less-active precursor forms, or retinol, which is the more active forms.

The reason that those labels don’t specify that is that in theory, and in actuality, some beta-carotene can get converted into the more active form, retinol, which we really need, but that conversion varies tremendously from person to person. And some people don’t do it at all. If you’ve ever met someone who did a juice fast, and their palms turned orange when they were doing that juice fast, that’s a person who doesn’t convert carotenes into retinol very well, and those carotenes built up, and you could actually see that pigment in their skin. I don’t remember the exact numbers, but I think it’s somewhere between 3% and 40% of the carotenes can get converted into retinol.

So, that’s a very broad range. Like, if you’re someone who’s 3%, then you can eat red peppers and carrots all day long. You’re still gonna end up being deficient in retinol unless you’re eating, you know, liver and other sources that give you that preformed retinol. Whereas if you’re someone who’s at 40%, at the high end of that conversion, you’ll probably do fine with a mixed diet, you know, with some vegetables and some animal products. And this is a bit of a tangent, but I’m gonna mention it anyways.

I think this explains, what we’re talking about right now, explains why there’s such a big variation in how people do on vegan and vegetarian diets. You have some people who can do really well for a long period of time. They’re probably the folks who are really efficient at converting these precursor forms of nutrients that are found in the plants to the active forms that are found in the animals. Whereas when people really struggle right off the bat, almost, they’re probably people who are not very good at making those conversions, and so they do better eating the animal foods, because the animals have already done that conversion, and they have the more active forms of nutrients, like heme iron, and retinol for Vitamin A.

So, when it comes to Vitamin A, I think there are a lot of people who are, on paper, getting enough Vitamin A, if you include the carotenes and the precursor forms. And so when you look at statistics for Vitamin A deficiency, like, what’s reported is pretty low, but I think that’s because they’re including all of the forms of Vitamin A, including carotenes. Whereas if we were to look specifically at retinol, the active form of Vitamin A, I think, like you said, almost nobody is getting enough. And that’s problematic, because retinol is, you know, while carotenes do have some functions in the body, it’s really retinol and the active form of Vitamin A that is most important.

So, yeah, I really encourage people to eat the preformed sources of retinol. So, those would be the animal products, and particularly organ meats and shellfish. And here’s the interesting thing. Although Vitamin A can be toxic at high doses, it’s pretty rare to see any toxicity from dietary sources alone, rather than just high doses of Vitamin A in supplements. And number two, the fat-soluble vitamins work together in a synergistic way, to lessen the risk of toxicity from any other fat-soluble vitamins. So, put that another way, the toxicity threshold for Vitamin A is far higher when you’re getting adequate levels of Vitamin D, Vitamin K2, and Vitamin E. It’s so high, in fact, that it would be very difficult to exceed that threshold. However, if you’re deficient in Vitamin D, which, as we saw, over 90% of Americans are, according to some surveys, and if you’re deficient in Vitamin K or K2, which, again, is very common, then the toxicity threshold of Vitamin A comes down. And certainly, when people are supplementing with it, they need to be careful.

Katie: Got it. Yeah. It’s not a popular suggestion, but one thing I do is, a few times a week at least, I’ll swallow some pieces of raw liver that have already been previously frozen from a local farmer, that I know the sourcing on, and that way I’m getting the fat-soluble vitamins in the liver. And I don’t like the taste of it, but it’s an easy way to just get the nutrients without really having to taste it.

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I feel like another important part of the conversation related to nutrient deficiencies is also, kind of twofold, but one being absorption, which is gut health-related, and also very talked about declining level of nutrients in the soil. So, even the sources we used to get more of these nutrients from might not have as much as they used to. So, let’s talk about those a little bit, maybe touching on the gut health side first.

Chris: Yeah. I mean, this is difficult to quantify, but we know if you look at statistics for IBS and other common gut conditions, that, you know, these are not rare at this point. You know, IBS is the second-leading cause of people missing work, just behind the common cold. And, you know, you have other conditions like GERD and dyspepsia, SIBO, ulcers, etc. All of these profoundly influence our ability to digest and absorb nutrients from the food that we eat. And so, I do think that one of the reasons that nutrient deficiencies are so common today, and are continuing to rise, is this epidemic of digestive issues that we have. So, on top of all of the other issues that we have talked about, even if you’re getting the nutrition side right, and maybe supplementing with additional nutrients that are hard to get enough of from food, then you have to consider your ability to digest and absorb them.

And there are all kinds of conditions, that are not even strictly digestive conditions, like hypothyroidism, which can decrease intestinal motility, and interfere with absorption. You know, type two diabetes, there have been shown to be changes in the intestinal microbiota. You know, there are lots of other conditions that you wouldn’t necessarily think of as being a digestive problem, that can interfere with absorption. So, I think that’s a really big issue.

In terms of soil quality, this is not my area of expertise, but I know enough about it to understand what the problem is. And the soil scientists that I’ve spoken with suggest that it’s not so much that the nutrients are no longer in the soil, it’s that we’re not able to extract those nutrients to the same degree that we used to be. And the reason for that is, essentially, that the biome of the soil has changed. In the same way that our own gut microbiome has become degraded over time, the microbiome of the soil has become degraded due to chemical fertilizers, and monocropping, and so many of the other industrial farming practices that we’ve been doing for so long, that changes the biome of the soil in a way that makes it more difficult for us to extract the same level of nutrients.

And these are not small changes. I’ve seen one study that estimated that in order for us to get the same nutrients from one orange that our grandparents would’ve eaten, we need to eat eight oranges to get that same level of nutrients. So that’s a profound difference. We have studies, for example, showing that between 1940 and 1991, the magnesium content in vegetables in the U.S. decreased by almost 25%, in fruits, almost 20%, and 15% in meats. And in the UK, that decline was even greater. It was close to 35% decrease in magnesium levels in that period of time alone. So, these are two really big problems, I think, that are also contributing to widespread nutrient deficiencies. And I would also add a few more.

So, number one is just the increase of toxins in our environment and our food supply. And these toxins, like glyphosate, can lead to changes to the gut microbiota that interfere with food absorption, and they can just interfere on their own with absorption. The same is true for heavy metals like mercury and lead, which have become pretty common in our food supply. And then, lastly… Well, not lastly, because there’s several other factors, but I’m gonna stop here, chronic disease itself actually interferes with nutrient absorption, and it increases the demand for nutrients. So, it’s a double whammy situation, where, if you have a chronic disease, that’s putting a stress on the body, and that stress increases the…essentially, if you think of it as your personal RDA for each nutrient goes up when you’re in a stressful state, because stress depletes nutrient levels.

At the same time, most chronic diseases will decrease the amount of nutrients that you absorb from the food that you eat. So you’re getting hit on both sides when you have a chronic disease. And we know that 6 in 10 Americans have a chronic disease, and 4 in 10 have multiple chronic diseases. So, when you put all of this together, you know, decline of our ability to extract nutrients from food, increase of toxins in the food supply, the rise of chronic disease that affects, increases the demand for nutrients, it’s really no wonder that so many people are struggling with nutrient deficiency.

Katie: And in a minute, I wanna switch gears and get into some solutions, some specific ideas for that, but I also wanna make sure we touch on the role of kind of really specific diets, because I see more and more people turning to things like, whether it be vegetarian or vegan diets, which don’t have any animal sources of protein or animal sources of anything, or people now going to the other extreme and doing the carnivore diet, which excludes all plant foods. So, I’d love to talk about maybe are there an increased risk for deficiencies in either of those two cases, and maybe also let’s touch on things like polyphenols and phytonutrients, and the role that they play in health?

Chris: Yeah. It’s a really good question. And it is something that I’ve been concerned with over the last several years. And I wanna be really clear here, because I don’t think that most people do really, you know, significantly restricted diets for fun, you know? Most people are doing, like, a carnivore diet or, you know, extremely low-carb diet or a low-FODMAP, you know, combination of low-FODMAP and AIP, because they’re desperate. You know, they’ve had serious health challenges, and they’re looking for something that can help them feel better. And I know this because I was one of those people myself, and I’ve treated people like that for, you know, almost a decade and a half. So I very much empathize with the reasons behind doing these diets, and I also recognize that these diets can be miraculous for some people, in terms of their ability to, you know, stop and even reverse symptom progression. So, I’ve seen people adopt the carnivore diet who were, you know, barely functional, and just had so many symptoms, they were really just the sickest of the sick, and then they start a carnivore diet, and it’s almost like magic, you know. So many of their symptoms improve.

Now, having said that, that doesn’t mean that these strategies are not without risk. And I think, as human beings, it’s difficult for us to accept situations like that. There’s some kind of cognitive challenge for us, where it’s hard for us to hold, like, in the same breath that something could be really good for us, and also could present risks for us at the same time. We tend to think more black and white. If it’s really good in the short term, it must be really good in the long term. Actually, that’s not necessarily the case. You can fast, for example, and feel amazing for the five days that you’re fasting, but I think we all know what will happen if you continue fasting for an extended period of time. You’re gonna die. So, that’s a good example of something that can have amazing short-term benefits, but can actually be fatal if we do that strategy over the long term.

So, yes, I think that with a carnivore diet, with AIP, and low-FODMAP, low histamine, and many people doing some combinations of all of these diets, or even intermittent fasting, where somebody is compressing their food intake into a small window of time during the day, let’s say six hours, and they’re not eating the same number of calories during that period that they would eat if they were eating three meals a day, you don’t need to be a math genius to understand that with a lower amount of food, you’re going to, by definition, have a lower level of nutrients that you’re taking in.

And so, I’m glad you brought that up, Katie, because I think that’s actually another, you know, perhaps less common and widespread, because we’re talking about a smaller niche of people that are doing these diets, but they’re increasingly common. And so I think it’s becoming a challenge for people to meet their micronutrient needs when they’re on these special diets. And I’ll tell you that my bias as a clinician has always been to expand people’s diets as much as possible, within the range of healthy foods that we talk about. It’s never been like, “Oh, let’s just, like, keep taking foods away, and then just stay with that.” I’m always challenging people, actually, to expand their diet, even if it’s uncomfortable, to include more foods, because I think this is such an important issue.

Katie: And that segues perfectly into my next question, which is how… In an optimal situation, obviously, taking into account that there’s a lot of variation and personalization, but what would be some areas that we could focus on to make sure we are trying to get as much nutrient density from our food as possible, as far as general categories, specific foods? I know you mentioned at the beginning some very, very common deficiencies. So, on average, not taking into account, obviously, testing, which would be ideal, what are some general, like, really nutrient-dense foods and/or categories that you would have people focus on?

Chris: Yeah. Well, you won’t be surprised by my answer, of course. And, you know, the answer is the same because the research has not changed. And, in fact, it’s only gotten stronger. I’m not sure if you saw, Katie, this paper that Ty Beal and his colleague, Flaminia Ortenzi, published a little while back in the journal “Frontiers in Nutrition.” It was a phenomenal paper. There have been many papers before that have quantified the nutrient density of foods. And just to say what that means, nutrient density looks at the concentration of nutrients in a given quantity, usually weight, you know, grams or ounces or a serving size of food. So, if you have a food that is extremely calorie-dense, like, let’s say sugar or bread, but is extremely low in nutrients, that’s a food that would be…is not very nutrient-dense. Whereas if you have a food that is relatively low in calories but very high in nutrients, that’s a nutrient-dense food.

So there have been studies that have set out to do this in the past, and many of them have been great studies, but one of the main issues that they suffered from is they didn’t consider the bioavailability of nutrients. And by that, I’m referring to how much we absorb of a given food that we eat, how many nutrients we absorb from that food. We might think that, oh, if we look at a food label, like spinach, for example, and we see, oh, spinach, has such-and-such milligrams of calcium, that that means we’re going to absorb all of those milligrams of calcium that are listed on the paper. That’s not the case. Absorption is never 100% of what the food contains, because there are certain substances in foods, compounds like phytic acid or oxalates, in the case of spinach, that decrease the absorption of certain nutrients. So, while on paper, spinach has a lot of calcium, if you just eat spinach, you’re not gonna absorb that much of that calcium, because it’s bound up in the oxalates that are in that spinach.

And so we’ve known this for many, many years, but most studies have not taken this into account. So, what I loved about this study that Ty Beal and Flaminia Ortenzi did is that they assessed the nutrient density of foods, but they did consider bioavailability. And what they found was that if you look at the top… I have the chart in front of me. If you look at the top, let’s see, one, two, three, four, five, six, seven foods. I’ll read them off. Liver, spleen, small dried fish, dark green leafy vegetables, bivalves, so, that’s shellfish, like oysters, kidney, and heart. So, of those seven top nutrient-dense foods, four of them are organs, liver, spleen, kidney, and heart. Two are specific kinds of seafood, so, small dried fish, and then shellfish. And then we have dark leafy green vegetables being the only plant food that’s in that in that top level. And this nutrient density was assessed as a score. So, the lower the score, the more nutrient-dense, in this particular framework that they were using.

And just to give you some comparisons, liver had a score of 11. That was the number one, at the top of the list. Let’s see. Other vegetables, beyond dark leafy green vegetables, were 380. So that’s much, much lower of a nutrient density score. It’s a higher number, but in this framework, it’s a lower score than liver, which was 11. Then we can go down to something like quinoa, which, you know, a lot of people think of as nutrient-dense. That’s 789. We go down to unrefined grain products. So, these are whole grains. Again, “healthy whole grains” is a phrase we heard a lot growing up. And the idea that these are, you know, really nutrient-dense foods. Unrefined grain products are 1,175. So, again, liver was 11, and lower is better.

And then we go down to refined grain products and refined grains. Those have a score of between 2,381, and then some refined grains were above 4,000, relative to a score of 11. So, what does this mean? It means organ meats and shellfish are, like, super power foods, that are so much more nutrient-dense, even than muscle meats, like steak or beef or chicken, things that people tend to eat a lot of in our culture. Those are nowhere near organ meats and shellfish on the nutrient density charts. And I’ve often said this, and I sometimes get in trouble for it. You know, I’ve said it on a couple of the Rogan appearances. I think it would almost be better to be a vegetarian that eats organ meats and shellfish, of course, then you’re not a vegetarian, but if you eat organ meats and shellfish a few times a week, than it would be to just eat muscle meats, with no organ meats or shellfish, because, you know, in that case, you could still end up not getting enough of certain key nutrients.

So, I’ve always been a huge advocate of people adding in organ meats, shellfish, small fish into their diet, because they are just at a whole different level when it comes to nutrition. And, yes, dark leafy green were way up there, too. So, you know, I personally eat a lot of those kinds of greens. When we can, we grow them ourselves, you know, climate permitting, and then, you know, farmer’s markets, and being able to get, like, lots of different types of dark leafy greens is a really good way to incorporate those into your diet.

Katie: Wow. I had to guess what the top foods were gonna be, but I didn’t know the details of that study and how drastically that was gonna be the case. And the good news, for any moms listening who have budgetary concerns is, on average, things like grass-fed liver and certain types of shellfish and small fish are relatively inexpensive sources of protein as well, when you’re talking about a family. So if you can figure out ways to incorporate them in your family’s diet, this is a great way to up everybody’s nutrient levels without going through a lot of budgetary expense.

But also, you mentioned earlier that we would take eight oranges to get the nutrient density of one orange our grandparents would’ve eaten, which to me brings the question of, is it even actually possible to get enough nutrients from diet anymore, or are we at a point where supplementation is actually a really important insurance policy, kind of across the board? And I know this was something that was top-of-mind for you, and that you’ve actually worked on creating solutions for this, but I guess to start, just, are we at a point where we actually do need supplements at this point?

Chris: You know, I have to say, Katie, I’ve changed my mind about this over the course of my career. Early in my career, I was pretty hardcore about, you know, getting all of our nutrients from food whenever possible. And I recognized even then that that wasn’t always possible with certain nutrients like Vitamin D, which, you know, if people don’t have adequate sun exposure, there aren’t that many food sources of Vitamin D, and so I knew that many people had to supplement Vitamin D. Also nutrients like magnesium, which I was aware, you know, the amounts of magnesium in soil have declined so much over the years, and issues like the RDA for magnesium that we talked about earlier. But I still really believed in my heart of hearts, I, to be honest, hoped that it would be possible for us to meet all of our nutrient needs through food.

At this point, having been through what I’ve been through, and seeing what I’ve seen as a clinician, treating patients for 15 years and testing all of them, as I said, I have done, with all of the different methods, and seeing how common nutrient deficiency is, even in people who really have their nutrition dialed in, and then seeing all of the studies on the prevalence of nutrient deficiency that we talked about, and then understanding all of the modern challenges that are affecting nutrient intake, and how much nutrition that we need, like, you know, the increase in toxins, the changes in the soil microbiome, the increase in people following special diets, etc., I do think now that most people are going to benefit from some ongoing supplementation, just to help close those nutrient gaps that have become pretty wide, and in some cases, gaping, in the modern world, and just to help feel and perform their best. You know, again, we’re not talking about just getting by and surviving. That’s not what I want. I think that’s not what most people listening to this show want. We really wanna thrive, and feel fantastic, you know, in each moment, and we also wanna give ourselves the best chance of living a long and healthy life, so we can do the work we wanna do, be there for our family, and just enjoy this amazing world that we live in.

And so, this is actually why, over the last several years, I turned my attention to creating a solution that could help people to close those nutrient gaps, and kind of, I like to say, add back in what the modern world has crowded out. Because this is a modern problem. A lot of the things we’ve been talking about throughout this show weren’t an issue, even 50 years ago, much less 5,000 years ago. So, we’re living in a fundamentally different time now. We have fundamentally different challenges, and I think we need to change our approach accordingly. And I admit that I was slow to do that. I really was hanging on to my belief that we could do it all with food, but eventually, reality got the better of me, and I really started to understand that although food needs to remain, in my opinion, the foundation of any nutrient strategy, like, I’m not a fan of, like, these soylent green type of products, where you just drink a smoothie with, you know, a whole bunch of vitamins and minerals in it each day, to several times a day. It’s not even a smoothie. I don’t know what you would call it, Katie, but, like, a blend of powder, with nutrients. I still think we need to build our strategy on a solid foundation of nutrient-dense food, and we can take that to the next level with smart supplementation.

Katie: Yeah. I’ve said many times on here, you can’t out-supplement a poor diet. And I think we’re very much, to your point, in a both/and situation, where we also may no longer be able to just get it from diet alone, but it makes total sense that the best outcomes would happen when you get both. And especially when you talked about the synergy of different nutrients and how they need to be in ratios, it would seem like making sure your diet is really dialed in and foundational first, and then getting the supplements as well, is gonna be a good way to help make sure that you’re assimilating these things, and getting them in the correct ranges. And then, of course, beyond there, there’s the personalization level with gut health, and with addressing any other underlying conditions, which I know your clinic does a lot of work around as well. For anyone who, I’m sure, has learned a ton from this episode, and I feel like we could do nine more episodes and still not even cover everything, but where can people find you online to keep learning, because you have so much educational content, and also, where can people find the new supplements?

Chris: Yeah. Thanks, Katie. So chriskresser.com is my main website. And that’s where we have tons of free eBooks and articles. You can also learn more about my podcast, “Revolution Health Radio,” and how to follow me on social, and, you know, always just sharing lots of great content about how to optimize your health, and thrive in this crazy modern world that we’re living in now, and to learn more about the supplements… To learn more about the supplements, just go to adaptnaturals.com. That’s the name of the brand, and it’s basically a daily stack of five products that I curated, based on my many years of clinical experience and my research about what most of us are not getting enough of, and what is really gonna help us to feel our best. And so, again, that’s adaptnaturals.com. Katie, thanks so much for having me on the show. It’s always such a great experience to talk with you. You’re a wealth of knowledge, and I really appreciate the work you’re doing in the world.

Katie: Likewise. And I hope we can do another round someday, because it’s always so fun to learn from you, but thank you so much for your time today.

Chris: Absolutely. Thank you, Katie.

Katie: And thanks as always to all of you listening for sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of “The Wellness Mama Podcast.”

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.