The Modern American Diet (MAD), or the Standard American Diet (SAD), is high in added sugar, refined carbohydrates, saturated fatty acids, and seed oils, and void of fiber, plant variety, and phytonutrients. Nutrition is at the forefront of human health. Americans' diets can provide the required nutrients to support health or the means to push an individual closer to disease. Nutrients essential for health include macronutrients (fats, carbohydrates, and proteins) and micronutrients (vitamins, minerals, and polyphenols).
Nutritional adequacy is described as meeting the nutrient intake recommendations defined by official guidelines. On the other hand, nutritional inadequacy involves failing to meet the estimated average requirement (EAR) for nutrients. Failing to consume adequate nutrients may result in a clinical deficiency, the most well-known being scurvy, a vitamin C deficiency. The Dietary Guidelines for Americans (DGA) 2020-2025 is a blueprint of what citizens should strive to consume to favor health promotion, not just disease treatment. Out of a score of 100, Americans score an average of 59 across all age groups for adherence to the dietary recommendations. That leaves a large area for improvement for Americans. Failing to consume the minimum amount of various nutrients can lead to symptoms of fatigue, immune complications like a reduced capacity to fight infections, and even altered brain function. It may also contribute to the risk of chronic health conditions such as cardiovascular disease, type 2 diabetes mellitus (T2DM), and osteoporosis.
The Quality of American Diets
Americans are eating more calories than ever but are still falling short of nutritional adequacy. In other words, their food choices are calorie-rich, but nutrient-poor. According to the 2020-2025 Dietary Guidelines for Americans, 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 Nutrient Intakes by Gender and Age in America
The following data are possible due to the collaboration between the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (DHHS). Unique to this dataset is that it follows the nutrient intake up until pre-COVID-19 pandemic times (from 2017 to March 2020). The following is the percentage of the United States population below the EAR for various nutrients based on the combined intake from food, beverages, and dietary supplements by gender and age:
*Adequate intake is the estimated amount of a nutrient consumed by healthy individuals that is considered adequate for the population’s needs.
The Impact of Soil Health on Nutrient Availability
Now, combine this poor nutrient intake 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.
The Rise of Appetite-Suppressant Medications on Nutrient Intake
Despite the unaffordability of certain weight management medications, such as glucagon-like peptide 1 (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-1 agonists 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.
Filling the Nutrition Gaps in Americans
Most Americans fail to meet recommended dietary guidelines. Regarding health outcomes, the nutrients of primary concern include iron, potassium, calcium, dietary fiber, and vitamin D. Several factors contribute to nutritional inadequacy. Some factors are within the control of the individual to change, such as multivitamin/mineral use or GLP-1 agonist use; some are not, like the nutrient profile of the soil where your food was grown. A multivitamin/mineral was associated with higher intakes of several micronutrients, including vitamin D, folate, vitamins B6 and B12, and the minerals iodine and selenium. Additionally, the percentage of Americans who successfully consume the estimated average requirement (EAR) from food/beverages for vitamin D, calcium, potassium, and iron is less than the percentage of Americans who successfully achieve the EAR with additional supplements. See below (based on 2017 to 2020 pre-pandemic):
Addressing the nutrient gaps propelled by 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 vegetable, fruit, and whole grain intake.
By Bri Mesenbring, MS, CNS, LDN
Designs for Health has been dedicated to being the most trusted source for superior quality, science-based nutritional products for nearly three decades. We’re committed to maximizing successful health outcomes by providing healthcare practitioners with comprehensive support through our extensive product line, ongoing clinical education, and practice development programs. The blogs we publish here cover a range of topics, including new and original approaches to diet and healthcare, analyses of the latest cutting-edge research, deep-dives into specific nutrients, botanicals, nutraceuticals and more, all fully referenced for those who want to dig deeper into the primary literature.
