The German Society for Nutritional Medicine (DGEM) estimates that 50,000 deaths per year are caused in Germany by nutritional deficiency. Often, this problem only manifests itself when the consequences of inadequate nutrition are already serious.
"In most cases, at first, we don't notice anything," says Matthias Pirlich, a doctor specializing in nutrition and internal medicine and former vice-president of the DGEM. "You can have a severe vitamin D deficiency for months, or even longer, before symptoms appear. The same goes for vitamin B12. And when symptoms finally appear, like nerve damage, it's actually already too late."
One example is prolonged vitamin B12 deficiency. A lack of this nutrient can damage the spinal cord and cause numbness in the limbs, muscle weakness or signs of paralysis. Brain damage, which occurs less frequently, can lead to memory disorders and psychological problems.
What is nutritional deficiency?
All B vitamins are important for metabolism, blood formation and the functioning of the nervous system. Along with several minerals, such as calcium, magnesium, iron, iodine and zinc, they are part of micronutrients. The body does not produce them on its own and needs to obtain them through food.
For the body to have an adequate supply of nutrients, micronutrients are as important as macronutrients, which provide energy, that is, carbohydrates, proteins and fats.
When the body ingests, for a long period, less food than is necessary to maintain all bodily functions, it is called malnutrition. According to current estimates by the Food and Agriculture Organization of the United Nations (FAO), around 645 million people suffer from chronic malnutrition.
In nutritional deficiency, the person ingests enough calories, but is lacking certain macronutrients or micronutrients. This also causes long-term illness and can even be fatal. Around two billion people around the world suffer from this so-called "hidden hunger", most of them in the Global South. But even in industrialized countries, many are deficient in important micronutrients.
A study carried out by researchers in the United States showed that, between 2007 and 2010, almost three-quarters of the country's population did not meet the recommended daily intake of vitamin D, and more than two-thirds fell below the recommended amount of vitamin E.
In Germany, according to the German Nutrition Society, around a third of the population was vitamin D deficient in 2017. This deficiency leads to pain in the bones, joints and muscles, in addition to increasing the risk of falls and fractures.
Furthermore, around a third of Germans also did not consume enough iodine. Iodine is an essential and indispensable trace element for the production of thyroid hormones. Its deficiency leads to pathological changes and other disorders of the gland. During pregnancy, the development of the baby's brain and nervous system depends on an adequate supply of this nutrient.
In some cases, growing agricultural varieties selected for greater durability or yield can also reduce the micronutrient content in fruits, vegetables and grains. However, the extent to which this affects human health is still debated.
The causes of "hidden hunger"
"Hidden hunger" can result from an unbalanced diet that, although it satisfies hunger and provides energy, lacks micronutrients. Examples of "empty" calories include fast food, highly processed foods, white bread and white rice.
Poverty is often the cause of this type of diet. A German study shows that families in situations of socioeconomic vulnerability tend to consume foods with low nutrient content and high caloric density.
The risk of nutritional deficiency also increases in cases of depression. "These people often suffer from a loss of appetite and, when they stop taking care of themselves, they can end up adopting a very unbalanced diet", says Matthias Pirlich.
Research conducted by the specialist showed that the elderly and people who live alone are also at greater risk of developing nutritional deficiencies. Furthermore, the risk increases as the number of medications used increases.
Diseases impact nutrient absorption
Many diseases make it difficult for the body to absorb or use nutrients. This is the case with inflammatory or chronic diseases, such as Crohn's disease, celiac disease, liver disease and cancer.
The DGEM estimates that, in Germany, around 30% of hospitalized patients are affected or at risk of nutritional deficiency. However, only about 1% of them are examined and treated to detect such deficiencies, according to data from health insurers. Often, nutritional status worsens even further during hospitalization.
The consequences can be serious: more complications, delayed wound healing, longer hospitalizations and higher mortality. This generates additional costs estimated at billions of euros for the healthcare system every year.
Therefore, German authorities and medical entities intend to develop, by the end of 2027, a plan to improve the identification and treatment of nutritional deficiencies in hospitals. The Netherlands can serve as an example, as in that country all patients undergo systematic screening to detect nutritional deficiencies upon admission to hospital.
How to prevent?
Matthias Pirlich argues that this type of screening should also be carried out for risk groups in offices and outpatient care. "This includes all people with chronic and serious illnesses and, especially, the elderly."
To prevent malnutrition associated with poverty, it is essential to ensure access to healthy food. “One idea [for Germany] would be to offer free school meals,” says Pirlich. Who pays for hot meals in German schools depends on several factors, as each federal state adopts its own rules.
In the city-state of Berlin, for example, lunch is free. In other states, however, it may be paid for by parents or financed partially or completely by subsidies and social assistance programs aimed at low-income families.
In general, the nutritionist recommends eating as varied and plant-based as possible. "The different phytochemicals have very positive effects and, when our diet is varied, we consume a wide range of nutritionally beneficial foods."
The basic rules are simple: the more colorful the dish, the better. Vegetables should be prepared as gently as possible, as overheating and prolonged exposure to high temperatures destroy vitamins. Storage for long periods also reduces the vitamin content of foods. Therefore, the ideal is to prioritize seasonal and regional products.
Despite all efforts to maintain a healthy and balanced diet, it is still possible to develop nutritional deficiencies. A blood test can detect this deficiency. And, when necessary, dietary supplements can help correct the identified deficiency.
