"Look at these cracks," 26- year-old Mitchell directed my attention to an irritated sore exactly at the corner where his two lips met. "Can I do anything about them because they hurt?"
Absolutely, I assured him. Those distinctive cracks when they appear only at that spot are called cheilosis or angular cheilosis. Cheilosis is a classic sign of riboflavin (vitamin B2) deficiency. It is one of the fun factoids taught in Nutrition 101 classes that is good to know before freaking out and thinking you have come down with an odd form of herpes.
Mitchell was health-conscious and ate well, so the idea that he could be nutrient-deficient was disturbing to him. "What foods should I be eating?" he wanted to know. I explained the best sources were dairy products, but eggs, leafy green vegetables and lean meats also contain the nutrient. Mitchell had been allergic to dairy products his entire life so eating them was out of the question. He was a pretty good spinach eater but clearly even if his intake was sufficient, absorption or other issues were at play. I recommended a dietary supplement but his question made me think about how often I see classic nutrient deficiency symptoms among the well-fed, right here in America.
There is a cultural myth that nutritional deficiencies are rare in Western countries. People always seemed shocked when I point out their symptom could be from a classic nutrient deficiency. If the client is hard to convince and the deficiency has a visual, I pull out my illustrated book of nutrient deficiencies and show them a picture. I do this reluctantly because the book is gruesome. It should be called Dr. Horrible's Book of Gross Things You Never Want to Have, or 100 Ways to Scare Your Kids into Eating Better. The cultural myth is perpetuated because nutritional deficiencies are often illustrated using pictures of suffering people from third-world countries. You almost expect to see an image of a pleading Sally Struthers superimposed on the devastating picture with the caption, "Please send what you can." Wouldn't it be nice if the average nutrition text used a picture of a well-coiffed woman in a St. John's suit to illustrate cheilosis?
The idea that nutrition deficiency is mostly a third-world problem is a cultural myth. Yes, about one-seventh of the people in the world are on the verge of starvation, which is obviously a pressing nutritional issue. It is disgusting that we let this happen when the Washington Post reported just last week that we throw away enough food to feed everyone. But starvation is only one type of nutritional deficiency. All kinds of nutritional problems happen way before severe deprivation. In this country we tend toward overeating, feeding the myth that the availability of food or overeating protects against nutrient deficiencies. Recently, I spoke to a man who was 50 pounds overweight. When I asked if he took supplements, he commented that he did not need them because he ate plenty of food. He was not considering the quality of his food or the fact that he had high blood pressure, pre-diabetes and gout.
You do not have to go to the Sudan to see signs of nutrient deficiencies. If you know what to look for, you can just go to the mall or peruse your family members. I see common nutritional deficiency symptoms all the time. True, you will probably not see the cornea deterioration associated with severe vitamin A deficiency (thank goodness), which is the most common cause of blindness worldwide, but night blindness, a milder symptom of vitamin A deficiency, happens occasionally right here in the US of A.
Here is a short list of common, everyday nutrient deficiency symptoms. Of course, most symptoms have many causes so there could be other reasons, but if you or someone you know has one of these symptoms, a nutritional cause should be considered.
Symptoms of Nutrient Deficiencies
Night blindness, poor light adaption -- Vitamin A
Keratosis Pilaris (chicken skin) -- Essential fats
Red, bleeding gums -- Vitamin C
Easy bruising, little red dots on skin -- Vitamin C
Decreased smell, taste -- Zinc
Deep fissures in tongue -- B vitamins
Rapid blinking eyes, muscle twitching -- Magnesium
Seasonal affective disorder -- Vitamin D
Due to the limited nutrition training of most physicians, you might want to mention these symptoms to your doctor, but may also want to consider seeing a nutritionist or naturopath.
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