Americans consume approximately 286 more calories per day than in 1977-1978. Today, Americans consume less potatoes, beef, eggs, milk, ice cream, and margarine, and more chicken, cooking oils, corn products, cheese, rice, and yogurt. Despite this increase in total calories consumed, Americans are falling short of nutritional adequacy. In fact, several nutrients, including vitamin D, calcium, potassium, dietary fiber, and iron, are labeled “nutrients of public health concern” because low intakes of these nutrients are associated with adverse health effects. Putting this into perspective, the percentage of Americans (aged one year or older) who are below the recommended dietary intake per food group is as follows:  

• Total Vegetables: ~90%
• Fruits: ~80%
• Total Grains: ~40%
• Dairy: ~87%
• Total Protein Foods: ~42%

Why Americans Become Nutrient Deficient
These data show that Americans do not meet the general nutrient or food group recommendations despite the increased total calories consumed. Numerous factors may contribute to this growing trend, including the increased intake of ultra-processed foods (UPFs), which have replaced a large percentage of total daily energy consumption in the population. Additionally, changes in soil quality, glucagon-like peptide 1 (GLP-1) medication use, and drug-nutrient interactions are associated with nutrient inadequacy. 

Ultra-processed Food Intake
Ultra-processed foods are hyper-palatable foods that are high in calories and low in nutrient adequacy. They represent 50% to 80% of an individual’s daily energy intake. UPF-based diets are higher in fat, carbohydrates, sodium, and added sugars and lower in dietary protein, fiber, and several micronutrients essential for health. Higher UPF intake is associated with decreased potassium, zinc, magnesium, and vitamins A, C, D, E, B12, and B3 intake. The concern with UPF intake is not only the excessive consumption of these food products but also what this high intake crowds out, namely, nutrient-rich foods. 

Soil Quality and Nutrient Availability
Combined with nutrient-depleted soils due to aggressive modern agricultural practices such as tilling, imbalanced fertilization, and single-crop fields, the once nutrient-dense topsoil has increasingly smaller amounts of nutrients. The nutrient quality of 43 fruits and vegetables was reported to have “reliable declines” in calcium, iron, phosphorus, vitamin B2, and vitamin C from 1950 to 1999. Relevant to the “nutrients of public concern” outlined by the DGA, the iron, calcium, and potassium nutrient content in 20 vegetables decreased by 22%, 19%, and 14%, respectively. 

Increased Use of Appetite-Suppressant Medications on Nutrient Intake
Despite the unaffordability of certain weight management medications, such as GLP-1 agonists, it is estimated that 12% of American adults have used them. The popularity of GLP-1 agonists, like semaglutide, has exploded in recent years due to their efficacy for weight loss, even at the two-year mark. One of the side effects of these medications is appetite suppression, which is one of the mechanisms thought to lead to the observed weight loss in trials. 

A relatively unexplored consequence of GLP-1s is reduced calorie consumption and, subsequently, the risk of lean muscle mass loss due to inadequate protein consumption. The challenge is that the combined factors of effective medication administration, appetite suppression, reduced calorie load, and diminished cravings may make it difficult for patients to consume adequate nutrients. These factors, paired with findings that energy intake from carbohydrates increases and from protein decreases after semaglutide treatment in patients with type 2 diabetes (after failed laparoscopic sleeve gastrectomy), underscore the importance of a comprehensive multivitamin and multimineral to support nutrient adequacy in these populations. 

Drug-Nutrient Interactions
Data from the National Health and Nutrition Examination Survey (NHANES; 2017-March 2020) indicated that about 49.9% of Americans used at least one prescription medication in the past 30 days. This figure decreased to 24% among participants reporting using more than three prescription medications in the last 30 days. The ten most prescribed medications include statins, calcium channel blockers, proton-pump inhibitors (PPIs), antidepressants, and anti-diabetic medications. 

With the growing trend of polypharmacy in individuals, understanding common drug-nutrient interactions may help support optimal nutrient adequacy. For example, PPIs are associated with potential vitamin B12, calcium, and iron changes. Antidiabetic medications may alter the normal absorption of vitamin B12. Certain antihypertensives are associated with changes in vitamin B6 and zinc status. Additionally, potassium excretion may be limited and should be monitored to prevent complications from hyperkalemia. Nutrient status prior to medication use, age, gender, and liver and kidney health are other factors that may influence drug-nutrient interactions. The use of targeted and personalized dietary supplements, which may include the use of a multivitamin and multimineral, may offer comprehensive nutritional support for those individuals most affected by drug-nutrient sequelae. 

5 Things to Do to Support the Nutrient Gaps in Americans

1. Include food sources that contain commonly lacking micronutrients like small fish, dark leafy vegetables, bivalves, goat, beef, eggs, milk, crustaceans, canned fish with bones, mutton, and lamb.
2. Choose organic for certain types of produce. Some vegetable varieties, such as zucchini and carrots, have been reported to have higher amounts of potassium than conventional cultivars. Organically grown carrots also show a higher concentration of carotenoids, a plant pigment found in orange, yellow, and red fruits and vegetables.
3. Eat purchased produce sooner rather than later. Produce can take several days to reach the dinner plate, which may contribute to nutrient loss. Eating produce as soon as possible after harvest may help support overall nutrient adequacy. 
4. Consider a multivitamin/mineral to support higher intakes of several micronutrients, including the nutrients of public concern. 
5. Check or ask your health-care practitioner to assess the drug-nutrient status of your medications. Understand if pharmaceutical use is affecting nutrient status. Targeted and personalized recommendations may be suggested to support optimal nutrient adequacy. 

5 Things to Avoid to Support Nutrient Quality

1. Reduce/avoid reliance on UPFs. UPFs are hyper-palatable foods with minimal nutrient density. Swap out favorite UPFs for similar nutrient-dense alternatives.
2. Avoid high-heat cooking methods. Steaming vegetables at lower temperatures compared with high-heat cooking methods (e.g., boiling) may help preserve the nutrient quality of certain vegetables. 
3. Reduce anti-nutrients in foods by soaking and cooking. Some foods, like grains and nuts, contain anti-nutrients, such as phytates, oxalates, and lectins, which minimize the absorption of certain nutrients. Soaking and cooking grains and nuts before use may help minimize these interactions.
4. Avoid an “all-or-nothing” mentality. Transitioning from a highly processed diet to a whole foods-based diet takes time. Start by making swaps for items regularly used, such as condiments, salad dressings, and snacks. 
5. Reduce repetitive food choices week to week. Variety in dietary choices is important for reaching nutrient adequacy. Regularly assess which foods are being eaten the most and cycle them with less frequently consumed foods. For example, if green foods are eaten the most and yellow foods are often ignored, focusing on yellow foods, such as bell peppers, pears, apples, bananas, and onions, will help support nutrient variety.

Addressing the nutrient gaps associated with poor food choices, declining soil quality, and medication use can be helpful. Multivitamins/minerals can support an individual’s health and nutrient status while practicing health-supportive lifestyle behaviors, such as increasing food sources of commonly lacking nutrients, buying organic produce, and practicing gentler cooking methods like steaming to help preserve nutrient density. 

To learn more about nutrient status, GLP-1s, and drug-nutrient interactions: 

Hungry for More: Nutrition Gaps in the Modern American Diet

4 Surprising Botanicals to Promote Normal GLP-1 Production

Drug-Nutrient Depletion

By Bri Mesenbring, MS, CNS, LDN