Episode 77 | Apr 4, 2024

From Diets to Supplements: Tackling Nutrient Deficiency, With Chris Kresser

Did you know that 90% of Americans are deficient in several micronutrients? Even those who eat a healthy and nutrient-dense diet are not always getting enough vitamins, minerals, and amino acids. Nutrients, both macro and micro, are some of the most confusing parts of health and wellness. In this episode, Dr. Sandi discusses all things nutrients with expert Chris Kresser to help you better understand what your body needs.

Chris explains the importance of nutrient synergy and how some nutrients work hand-in-hand to keep you healthy. He shares what to look out for when buying supplements, as well as what goes into creating quality supplements. Chris has made it his mission to provide safe and effective supplements to people worldwide.

Many Americans are unaware of what kinds of supplements they should take, where to purchase them, or the dosage they may need to live a healthy lifestyle. This episode will arm you with the information you need to make healthier choices.

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Episode Transcript

Dr. Sandi: What is one area in nutrition that is so confusing for many people? I think it has to do with nutrients. Can we get all of our nutrients from food? Do we need supplements? If so, what supplements should we be taking? You can go to the store, and you can be overwhelmed with the variety of supplements, the brands that are out there. How do you tell what’s a quality supplement for something that many of them might not be the best? They could even be harmful for you. So, we need an expert. And that’s why I brought on to “Health Coach Talk” today, Chris Kresser.

Chris has a wonderful background in functional medicine. He had trained health coaches, and he gets the role of health coaches, the important role that health coaches have in educating people about supplements: what’s a quality supplement, how to vet a supplement, how to read labels for example.

So, let me tell you a little bit about Chris Kresser. He is the cofounder of the California Center for Functional Medicine, the founder of Kresser Institute, the host of the top-ranked health podcast, “Revolution Health Radio,” he is the creator of chriskresser.com, and a New York Times best-selling author of “The Paleo Cure” and “Unconventional Medicine.” He’s one of the most well-respected clinicians and educators in the field of functional medicine and ancestral health, and he has trained over 2,000 clinicians and health coaches from more than 60 countries in his unique approach. He was named one of the 100 most influential people in health and fitness by greatist.com.

So, I think you will enjoy listening to my interview with Chris Kresser as much as I enjoyed recording it.

Welcome, Chris. It is such an honor to have you on “Health Coach Talk.”

Chris: Sandra, it’s a pleasure to be here. Thanks for inviting me.

Dr. Sandi: Thank you. So, let’s talk about nutrients because this is such an important topic, and I believe this is an area that coaches can talk about with clients. They, as you know, and our audience knows they do not recommend specific supplements, but they can talk in very general terms about the importance of nutrients and how you may need to supplement.

So, let’s start off by talking about nutrient density. Why is that so important?

Chris: Yeah, nutrient density is critical because it refers to the concentration of micronutrients and amino acids in a given food. And most of the conversation around diet over the past few decades has centered around macronutrients, which are protein, carbohydrate and fat. Of course, we’ve had the low-fat diet craze back in the ’80s and ’90s, followed by the low-carb diet craze, and lots of discussion about macronutrients, which is important. There’s no doubt that macronutrient ratios can make a really big impact on people’s health and well-being.

But completely absent from this discussion often has been the critical importance of micronutrients, which are vitamins, minerals, phytonutrients. Sometimes amino acids get included in that discussion, even though they’re technically part of protein. These are really critical. They’re essential in the sense that the body can’t produce them on its own. We need to obtain them from food. And if we don’t obtain the essential nutrients, we die.

Of course, up until the last 100 years and still in some parts of the world, diseases like scurvy, rickets, beriberi, and pellagra, which are caused by frank deficiency of nutrients like vitamin C or B vitamins, etc., were still significant causes of death and disability in many parts of the world.

Today, that’s no longer the case at least in the developed world, but nutrient insufficiencies, which are just falling short of the optimal level of a given nutrient that we need for health and longevity, are shockingly common. Most people unfortunately think this is a problem that only affects the developing world, but we know that over 90% of Americans are falling short of not just one but several essential micronutrients. So, this is a problem that affects you, it affects me, it affects our neighbors, our kids, our aunts, uncles, pretty much everybody we know despite the fact that we live in the richest country in the world.

So, this is why I have really dedicated this latest part of my career to focusing on this issue, because I think it’s the fundamental issue of our time.

Dr. Sandi: Would it be fair to assume we are not getting these nutrients from our food alone?

Chris: Oh, absolutely not. I mean, even if you’re eating a nutrient-dense diet, unfortunately that’s not true for most people. We know that 60% of the calories the average American consumed come from ultra-processed, ultrarefined foods. So, these are foods like flour and sugar, sugar-sweetened beverages, pizza, cake, cookies, muffins, crackers, chips, you know, the foods that come in bags and boxes and that we see in fast food restaurants, etc. And most of these foods are almost completely devoid of nutrients. They have shockingly little nutritional value, but we’re filling up on these foods.

Having said that, even those of us who are making better choices and eating wholefoods, there are challenges like declining soil quality and growing prevalence of toxins in the food supply that mean that we’re not absorbing the same amount of nutrition from these healthy wholefoods that our parents or grandparents did. So, one statistic that has always stuck with me that I read in a paper was that we’d have to eat eight oranges today to get the same nutritional value that our grandparents got from a single orange. So that’s just two generations, but it’s a remarkable and dramatic change in a short period of time.

Dr. Sandi: Yeah, that’s shocking. And of course, as a child growing up in the ’50s, I remember, you know, eating those oranges and obviously they are not the same. And what specific nutrients do you think people are most prone to be deficient in?

Chris: Linus Pauling Institute has some really good data on this question. They estimate that close to 100% don’t get enough potassium and close to 100% don’t get enough choline. So, that’s just crazy. If you think about 100%, that means virtually all of us are not getting enough potassium and choline. And those are two absolutely vital nutrients, particularly choline.

As we live longer and brain health becomes a growing concern, choline is a critical nutrient for the nervous system and the brain. And the fact that almost of Americans aren’t getting enough is deeply troubling in that context, 94% don’t get enough vitamin D, 89% don’t get enough vitamin E, 67% vitamin K. I would say…I skipped magnesium because I’ll come back to that. It’s a special case, but I would say over 90% don’t get enough magnesium, almost 50% don’t get enough calcium, 45% don’t get enough vitamin A, and the list goes on from there.

So, those are single nutrients, but again, as I said before, the average person is falling short on multiple nutrients. So, that’s a compounding problem because of a phenomenon known as nutrient synergy, which means that we often need the presence of one or more other nutrients to fully activate a different nutrient. So, I’ll give you a couple of examples. Copper is required for iron absorption and metabolism. So, if you’re copper deficient, you can exhibit all of the signs and symptoms of iron deficiency, even if you’re consuming enough iron because you simply won’t be able to absorb and utilize the iron that you are consuming.

And I saw this in my practice several times, people who come in, they would have iron deficiency anemia, and they had been to several doctors and they would say, “My doctor has given me iron supplements and even iron IV infusions, and I’m not getting any better.” We would measure their copper, they would be copper deficient. We would give them copper without even giving them any additional iron, and all of a sudden they would be feeling better and their iron stores would go back to normal.

Magnesium and vitamin D have a similar relationship. And it actually works in both directions where they’re both needed for the utilization and absorption of that particular vitamin or mineral. So, if you’re magnesium deficient, you will exhibit vitamin D deficiency symptoms and vice versa. So, because of this complex interplay between all of these nutrients, it becomes a situation where one plus one is more than two. It’s a synergistic impact. So, if you’re low in choline, potassium, vitamin A and magnesium, you’re also going to end up having deficiency symptoms of vitamin D, iron and other nutrients, even if you’re getting enough of those. So, it’s a compounding problem.

And unfortunately this interplay, this nutrient synergy is rarely even acknowledged by the conventional medical establishment. Even though it’s well documented in the scientific literature, it’s rarely discussed in these…when the question of nutrient deficiency comes out.

Dr. Sandi: Sure, that makes sense. And it’s such a shame. And most doctors will just say, “Oh, you don’t need supplements. You’ll just pee them out anyway. So, if you want to waste your money, that’s fine. You’ll just pee them out.” And that’s what I’ve heard over and over again.

Chris: Sandi, it’s crazy. You know, the arrogance of the medical profession never ceases to amaze me. And I don’t mean that as a judgment toward any individual doctors, many of whom I have great respect for and who I think have great hearts and are in it for the right reasons, but the profession as a whole if we can generalize is often stuck in an outdated paradigm that’s not serving patients and not serving themselves. And they’re often not…the current standard of practice is hopelessly out of date with what is in the scientific literature.

This is a good example of where I can pull up countless peer reviewed published studies that support what we’re saying here, and then you get a doctor who makes a comment like that, “Oh, supplements, you’re just going to pee them out. You don’t need them. We live in the United States. Rickets and scurvy, we solved those 100 years ago. This is a non-issue.” That’s just a completely ignorant opinion. That just tells me that that particular clinician has no familiarity with the scientific literature on this topic and is just speaking, frankly, completely out of turn, does not have an informed opinion whatsoever. And yet, unfortunately, that is what many people encounter when they go and have this kind of discussion with their primary care physician.

Dr. Sandi: Oh, absolutely. My husband was having a procedure, and he was being checked in with the nurse. And the doctor came in and so I was there and I said… They went through the whole list of medications and he’s taking a lot of them and we’re in our 70s, but he never…the physician never asked one thing about supplements. Like I said, “Well, don’t you want to hear that he’s taking vitamin D?” or, “Don’t you want to hear about his other supplements that I’ve got him on?” “No. Yeah, I mean, oh, sure,” but, you know, it was kind of irrelevant. It was an afterthought. They had no idea what I was talking about.

Chris: And then the problem goes deeper. The issue is not just with the medical establishment or physicians, of course—like I said, many of whom are doing excellent work—it’s just with the entire system. So, let me give you an example. I mentioned magnesium before as a special case. If you look at the published figures on the percentage of people that aren’t getting enough magnesium, you’ll see figures around 52%, 50%, 48%, depending on the study that you look at, which is still a really big number, right? One of two people essentially falling short of the RDA of magnesium.

But what that doesn’t tell you is that the RDA, the recommended dietary allowance, for magnesium is hopelessly out of date and is not sufficient any longer. And the reason for this is that the RDA is usually based on a number of different factors that include things like average body weight, right? So, the average body weight of American men and women has changed dramatically even just in the past 25 years. So, of course that would alter the RDA, but the RDAs have not been updated since 1991.

So, the current RDA for magnesium is 320 milligrams for women and 420 mg for women. And pardon me, they were last updated in 1997, not 1991. At that time, the average body weight for a female was 133 pounds and for male it was 166 pounds. Today, the average body weight for females is 169 pounds and 196 pounds for men. And, you know, basically like a 30-pound increase just not 25-year period. And

And so researchers published a study in 2021 saying, “Hey, we need to update these RDAs because the weights have changed during this period.” And when they did that, the RDA for females went from 320 milligrams per day to 535 milligrams per day. And for men, it went from 420 to 655 milligrams per day. So, then if you do the statistics to see what percentage of Americans are falling short using the updated RDAs that actually reflect our current body weights, it would be close to 100% of Americans that are falling short of magnesium.

So, that’s just one example of how just the lack of rigor and the lack of communication between the published research and the current standard of care and statistics is not serving us and likely hugely underestimates the already dramatically high rates of nutrient insufficiency.

Dr. Sandi: Sure. Is it possible to swing in the other direction? Can somebody be getting too many nutrients or taking… They come in with shopping bags full of supplements, but, oh, they heard this is good. So, they went out to the store and bought that. And they’re like, “Oh, I heard this is good. I don’t even know why I’m taking it, but I’m taking it.”

Chris: Absolutely. Yeah. I mean, I think that’s… Certainly a minority of people, nutrient deficiency is a more widespread problem, but it does happen, and there are specific nutrients of concern, right? And some nutrients, we don’t know of any upper limit in terms of toxicity, and you’ll likely just start to experience some side effects like vitamin C, for example. Most people know if you take enough vitamin C, you’ll spend a lot of time in the bathroom, but beyond that, you know, it’s not really a toxic nutrient similar with vitamin K2, vitamin B12. But there are nutrients where there absolutely is a toxic level. Selenium is a good example. Iron is another good example. Iron overload actually is an underdiagnosed problem, particularly in people of North American descent. Copper is toxic in high doses.

And so it is absolutely possible to go overboard with certain nutrients, and that’s why either working with a clinician who’s very familiar with this type of situation or choosing a company, if you are supplementing, that it was started by or has at least people on the formulation team that understand the upper thresholds of these various nutrients and then the role that the nutrients play synergistically together, which is another important concept.

So, for example, you often hear a lot about vitamin A toxicity. What many people don’t know is that vitamin A toxicity is greatly exacerbated by vitamin D and K2 deficiency, both of which are very common. If you have adequate levels of D and K2, the toxicity threshold for vitamin A rises dramatically, which is to say that you can take a lot more vitamin A or eat a lot more vitamin A without concern as long as you have normal vitamin D and K2 levels. So, all of these things should be taken into consideration ideally.

Dr. Sandi: This is a good segue to talking about your current mission and why you started Adapt Naturals, because a question that health coaches often get is, you know, can I just go to my local drugstore or Costco and get the discount brand? And why am I using this one? Because I can just go and get it much cheaper. I order it on Amazon, for example, where you don’t know where you’re getting. And so we train our health coaches that this is an area where you can educate people about what to look for in a quality supplement.

So, let’s start there in terms of what are the things people should be looking for in purchasing a supplement. And then how did you decide this is your mission to start a company like Adapt Naturals?

Chris: Great question. Well, I’ll start with the end and work backwards because it will inform my answer. I spent 15 years treating hundreds of patients and training over 3,000 healthcare providers and coaches in more than 50 countries around the world. And that taught me a lot about what people need to thrive, what nutrients people need to thrive and flourish and extend their health span. It also taught me how perilous the journey is often for people, just how much misinformation there is out there, how much snake oil. There is in the supplement marketplace. I mean, let’s face it. It’s a big industry with a lot of money being made and people enter into it with frankly pretty unsavory motives. You know, there are lots of supplement companies that were just started by marketers and people who wanted to make money.

There’s a saying, “Pills pay the bills.” And so I know of several supplement companies that were just started by people who entered it from the frame of mind of, “I want to go into ecommerce. I want to choose a profitable industry. And supplements look like that, so I’m going to start a supplement company. And when you enter into it with that mentality, even if you’re a person with pretty good integrity, it’s going to lead to a different decision making process than if you enter into it from the purpose of wanting to help people. And, you know, having spent many years helping people in a clinical context, you, sort of, learn where the bodies are buried and where the pitfalls are and where people and companies tend to cut corners.

So, after 15 years of seeing countless examples of that, I got just, kind of, fed up and decided that I wanted to start my own company and create products that I would want to take myself that, I would want to recommend to family members and friends and patients and that people in my community, which I’d spent, you know, almost 20 years building could just trust and know that they were getting high-quality, evidence-based, clinically validated products with premium ingredients that were sourced from U.S. CGMP manufacturers and produced in a tightly controlled environment. Validated third-party tested completely transparent. You know, all the things that I look for and would look for as a clinician treating patients and as someone taking supplements myself.

And so that was a big part of it for me, Sandi. And the other piece is, as you know, I started treating patients individually. And then I started training doctors and other clinicians. Then I started training health coaches. Each step of the path was, for me, an attempt to reach a broader number of people. You know, seeing patients one on one, there’s a pretty hard limit to the number of people you’re going to be able to help that way. Training practitioners was a great step because they went off and had their patients. And then training health coaches was great because they could reach even more people. You can train more coaches more quickly than you can clinicians.

But at the end of the day, there was still…I would say 95% of the people in my audience were people that I wasn’t able to help because they didn’t have access to a functional medicine clinician or even a health coach. And so I wanted to find a way to translate my years of clinical experience into a format that could reach as broad an audience as possible and create meaningful change in their life. And that’s where Adapt Naturals came from.

And so with that as the premise, I just started creating the products that I thought would be the foundational products that most people need on a day to day basis to stay healthy and well, and that’s what we’ve done. And from there, the plan is to continue to expand our product range to a few more foundational products that we’re still in the process of formulating and launching this year and next year and then some more specialized products for particular health conditions and goals as we go.

But it’s still very much a functional medicine focus, right? It’s products that actually address underlying mechanisms and root causes, including nutrient deficiency, and can help people heal from the inside out and live the life that they want to live. That’s always been my guiding purpose.

Dr. Sandi: Well, I personally take your line of supplements. I love that you have organs because I’m not a liver lover and I occasionally will make chopped liver.

Chris: You and most people.

Dr. Sandi: Yeah, but the fact that you have that blend as well as the medicinal mushrooms. And you make it easy. and that’s what I think is very attractive for somebody who is very confused what to take. So, this is trustworthy as well as trusting that it is made to the highest standard. And that is where I think coaches can play a huge role in helping people understand that there is a huge difference in quality control, and raw materials, contaminants, fillers, binders. And so if you could comment on that and how that somebody just goes and get something at a local discount store that they might not be getting a good product there.

Chris: Yeah, great question. I mean, we could spend many hours on this topic, but I’ll break it down in the case of a multivitamin. Let’s start there because that’s the most common supplement in the U.S. that statistically the majority of people now over 50 especially are taking a multivitamin. And I would say that most common multivitamins suffer from three problems, and you could extend this to a lot of different supplement categories as well. Number one is they don’t have enough of the nutrients that you need. So, they might have all of the nutrients or most of them on the label, but when you look at the amounts or the doses that they contain, they’re often woefully inadequate.

So, an example might be vitamin D. In many cases, the multi might have 400 IU of vitamin D which, as you well know, is insufficient for the vast majority of people to maintain adequate vitamin D levels. Most people will need at least 2,000 IU per day. That could go up easily to 5,000 or even 10,000 IU per day, depending on their health status. And people who are overweight or obese tend to need at the higher end of that range. And so even if it lists vitamin D, you can’t assume that you’re getting enough. The same is true with vitamin C, vitamin B12, magnesium, and many other nutrients. So, that’s number one, just not getting enough.

Number two is the wrong forms of the nutrients. So, this tends to show up a lot with B vitamins. So, there are cheap synthetic forms like folic acid or cyanocobalamin. Folic acid is B9 and cyanocobalamin is B12. These are cheap synthetic forms of these vitamins. They’re attractive for supplement manufacturers because they’re very cheap, and I know this because I have a supplement company. I formulate, I can look at price sheets and tell you they are dramatically cheaper than methylfolate, which is the active form of folate, or methylcobalamin, the active form of B12.

And so most supplement companies just use the cheaper forms because either they themselves don’t know, or they figure most consumers don’t know that those are going to not be as well absorbed as the active forms. It may even cause problems in people with MTHFR, polymorphisms, or other pretty common genetic polymorphisms.

So, that’s the big issue. And it’s not just true with B vitamins. It’s true with vitamin A, for example. You’ll often see beta-carotene or other carotenes, which are the precursor forms only. And you won’t see any retinol, which is the active form. With vitamin K, you often only see K1, you won’t see K2, which we know is very important and has distinct benefits above and beyond what vitamin K has. With selenium or other minerals, you might see forms that are not typically well-absorbed instead of the chelated forms or, like, use base form of selenium like SelenoExcell.

There are always forms of nutrients that are more and less bioavailable. And generally speaking the less bioavailable forms are cheaper, and the more bioavailable forms are more expensive. And so when you go into GMC or Costco or your general supermarket and just take a multi off the shelf and it costs $12 or $15, you should be wary because you cannot make a multi for $12 or $15 that will have these active forms of these vitamins without losing money. I know that first… I can tell you that with absolute certainty.

The last thing is too much of certain nutrients, which you brought up, Sandi. So, I said iron overload is a serious and often unrecognized problem. Calcium supplements have been associated with increased risk of kidney stones and cardiovascular disease. There’s just a lot of problems with high-dose calcium supplementation, which I’ve detailed at length in the past. I have an article about this on my website chriskresser.com. Iodine supplementation at high doses can be harmful, especially for people with Hashimoto’s, which is the most common autoimmune disease in the U.S. Too much copper can be problematic, etc.

So, you’ll often see multis or other supplements that have excessively high doses of these nutrients and, in that case, you’re not only not doing yourself any favors, you could actually be causing harm. So, this is the problem with many of the store-bought products. For better and for worse, because I think too much regulation sometimes can be problematic when it’s not well intentioned and then you have the downside, but the downside of that is that I could release a supplement tomorrow that had a toxic dose of copper in it and that would be permitted by the FDA and FTC currently. It could have 10 milligrams of copper and someone could take that every day for the next whatever period of time and do harm. And there’s nothing preventing companies from doing that.

So, that is an area where I think it’s challenging for the average consumer because they’re not educated understandably to be able to make these decisions. And that’s why it becomes even more important to find companies that you trust and to just be able to not have to think about that all the time.

Dr. Sandi: Absolutely. So, it’s buyer beware, and this is where health coaches can provide crucial education and also could help people see the advantage of “test, don’t guess.” And so finding nutrition professionals, going to your doctor, getting those tests, so that you will know your levels, for example.

So, this has been such a wonderful conversation, Chris. And I know that our listeners will want to know more. Where can they reach you? Where can they find out more about your work, your supplements?

Chris: Yeah, my website is chriskresser.com. We’ve got I think 1,200, 1,300 free articles there now, and of course 15 free e-books and lots of free content, including my podcast. And then Adapt Naturals is the supplement brand.

Dr. Sandi: Well, as I said, I take them personally. I look forward to more products coming out in your product line. And I want to thank you for being with us today.

Chris: Thank you, Sandi. I appreciate the invitation. It’s always a pleasure.