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The Missing Link: Nutritional Deficiencies and Skin

Contact Author Erin Madigan-Fleck, NMD

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In recent years, the cases of nutrition-related health disorders have risen substantially. Worldwide, two billion people are affected by micronutrient deficiencies, including vitamins A, C, E and the minerals zinc, iron and iodine. Malnutrition often perpetuates dire consequences including disability, stunted mental and physical growth, and even death. One notable nutrient deficiency that presents alarming statistics is iodine; it remains a significant yet preventable cause of brain damage and mental retardation worldwide.1

The Center for Disease Control’s (CDC’s) Second Nutrition Report, an assessment of diet and nutrition in the U.S. population, concludes there are a number of primary specific nutrients lacking in the typical American diet.2 Modern dietary tendencies remain both debatable and problematic, especially considering that processed foods frequently provide sub-optimal nutritional factors, chemical preservatives and artificial food colorings. For some, these are behind systemic sensitivities, allergies and inflammation.

Nutrient Deficiency and Malabsorption

Many nutritionists and physicians believe most states of ill health, barring accidents and trauma, are brought about by one or more of four main factors:

  1. Poor digestion. Causes include stomach acid insufficiency and/or poor digestive enzyme production/or stress effects.
  2. Food intolerance and allergies. Frequent consumption of irritating foods can lead to allergies.
  3. Nutrient deficiency. Causes include sub-optimum intake and/or poor absorption.
  4. Toxic overload. An inability to eliminate and excrete various substances can cause this overload.

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Nutrient deficiencies remain an ambiguous concern among many individuals. In fact, the notion that they may even occur remains an enigma for some. Unfortunately, the interpretation of “proper nutrition” is itself deficient in many respects, as widespread statistics illustrate. Undetected nutritional deficiencies may also present as asymptomatic; however, these can easily perpetuate to chronic symptoms, and may not present the resultant consequences until they become clinical manifestations.

The Nutrient Deficiency Chart3-5 lists several common nutrition deficiency characteristics and the possibly related nutrients.3-5 Note that this information is presented for educational purposes only and does not represent a nutritional recommendation or the identification of a disease or disorder. For the diagnosis of any disease or a nutritional prescription recommendation, please consult a physician.


A common doctrine exists among health care professionals: Balance, consistency and quantity ultimately affect one’s nutritional status and state of health. Nutrition is a balancing act, and functional protocols are adapted to suit individual needs based on deficiencies detected though laboratory evaluations, symptoms, age, height, weight, medical conditions and more. Nutritional science includes many facets vital to biochemical and functional processes the body needs to assimilate nutrients. These include bioavailability, malabsorption, diffusion, perfusion and nutrient absorption.

Malabsorption in particular is a widespread health condition. This involves the body’s inability to completely absorb nutrients in the small intestines, and it often is concurrent with gastrointestinal conditions. Medications, parasites, viruses, diabetes and other disorders also can affect intestinal absorption.

Spotlight: Magnesium

It is estimated that 80% of Americans are deficient in magnesium. Magnesium is the fourth most prevalent mineral found in cells after calcium, phosphorous and potassium. Enzymes critical to the development and repair of DNA require the antioxidant activity of magnesium to carry out their tasks. Also, without the protection of magnesium and other vital antioxidants, the skin is not likely to withstand assault from the most damaging of free radicals.

Magnesium is a crucially important mineral for optimal health, performing a wide array of biological functions,6 including but not limited to: activating muscles and nerves; cardiac health; activating adenosine triphosphate (ATP), to create energy in the body; helping to digest proteins, carbohydrates and fats; serving as a building block for RNA and DNA synthesis; and acting as a precursor for neurotransmitters such as serotonin.


Bioavailability refers to the transport and delivery of essential materials such as nutrients to the body. Factors affecting bioavailability include the availability, absorption, retention and utilization of nutrients consumed. Largely, bioavailability refers to the proportion of nutrients absorbed from the diet and used in normal body functions;8, 9 e.g., nourishing the skin.

Vitamins and minerals vary in size, quantity and function. In relation, nutrients feature active transports or “viaducts” that extrude the vitamin or mineral through the intestinal wall and into the body where they may be directly released or connected to another molecule. Absorption becomes a very specific task, as all nutrient exchanges require a great deal of energy for transport. It is important to note that even when an individual consumes the healthiest and most nutritious foods, if the functioning of their digestive system is faulty or compromised, so too is their ability to absorb and utilize nutrients.

The following are critical factors involving bioavailability and the digestive system:

  • Release of nutrients from the dietary matrix;
  • Effects of digestive enzymes in the intestine;
  • Diffusion across the gut wall into blood and lymph circulation;
  • Binding and uptake in the intestinal mucosa;
  • Systemic function and distribution;
  • Metabolic uptake and functional use; and
  • Phagocytosis and release of waste products.

Nutritional Prerequisites for Skin

With regard to the skin, specific macro and micronutrient deficiencies have been correlated to “skin signs” and dermal manifestations of the face and body. According to the Linus Pauling Institute on Micronutrient Research for Optimum Health, much of the role of nutrition in skin health focuses on the effects of deficiency, since the structural components of the skin are supported by a variety of nutritive factors, such as peptides, minerals and vitamins, which serve as enzyme cofactors, activators or inhibitors.9

Nutritional support of the skin is dependent on the following four elements to facilitate and utilize nutrients.

  1. Viable support network of connective tissue, collagen and elastin
  2. Adequate circulation and vascular integrity of the dermis
  3. Cellular hydration and a healthy framework of the epidermis including lipid functionality and trans-epidermal water loss (TEWL) ratios
  4. Skin immune response and antioxidant potential for free radical protection.

Nutrient Density

Foods containing an abundance of micronutrients are considered nutrient dense. Foods supply calories for energy from carbohydrates, fats and proteins. Micronutrients are obtained from vitamins, minerals and powerful components called phytochemicals or phytonutrients. Phytochemicals supply key compounds that protect against oxidants and combat free radicals. Foods with high nutrient densities are recommended over foods with higher calories, sugar content, bad fats and low nutrient densities.

The Aggregate Nutrient Density Index (ANDI) score serves as a beneficial guideline for selecting foods for optimum health performance and well-being. According to Joel Fuhrman, M.D., author of the Nutritarian Handbook and ANDI Food Scoring Guide, the ANDI system is designed to rank the nutrient value of many common foods on the basis of how many nutrients they deliver to the body for each calorie consumed (see Nutrient Densities of Food for examples).10


ANDI scores are based on 34 important nutritional parameters and are used to rate foods on a scale of 1-1,000, where the most nutrient-dense, green vegetables such as kale score 1,000. This demonstrates the nutritional value of nutrient-dense foods, compared with processed foods and animal products, which generally have high levels of fat, sodium and carbohydrates. To educate consumers about nutrient-dense foods, health food stores often provide brochures to consumers and even place signs near produce stands rating the particular nutrient density of fresh produce.


Phytochemicals are a large group of plant-derived compounds believed to be responsible for much of the disease-protection conferred from diets high in fruits, vegetables, beans, cereals and plant-based beverages. The best known phytonutrients are carotenoids, flavonoids, polyphenols, indoles, lignans and isoflavones (See Phytochemicals).


Carotenoids include the yellow, orange and red pigments in fruits and vegetables. Dark, green, leafy vegetables also are rich in the carotenoid beta-carotene, but its usual yellow color is masked by the green chlorophyll pigment.

Flavonoids are reddish pigments found in red grape skins and citrus fruits, while polyphenols are found in green tea and berries. Indoles are present in cruciferous vegetables, lignans in flaxseed, and isoflavones in peanuts, lentils, soy and other legumes.

More than 900 different phytochemicals have been identified as components of food, and more continue to be discovered through food science and research. It is estimated there may be more than 100 various phytochemicals in just one serving of vegetables. Also, fruit such as apples contain powerful flavonoids and polyphenolics among some 400+ phytonutrients and phytochemicals in total. This gives new insight to the old adage, “An apple a day keeps the doctor away.”


As modern dietary tendencies remain both debatable and problematic, it is important to stress the importance of sufficient nutrition to clients. Not only will this impact their overall health, but as the Linus Pauling Institute noted above, it will improve their skin health. With the variety of nutrient-dense foods available, clients have many options to improve their nutrition—allowing nutritionists and doctors to focus instead on questions of bioavailability, allergies, absorption, etc.


  3. PA Balch, Prescriptions for Nutritional Healing, 5th edn, Reference Guide to Using Vitamins, Minerals, Herbs and Food Supplements, Avery Publishing, New York (2010)
  4. RR Barefoot, Death By Diet—The Relationship Between Nutrient Deficiency and Disease, Bokar Consultants (Jan 2012)
  5. Werbach, Melvin R. MD, Nutritional Influences on Illness – A Sourcebook of Clinical Research – Keats Publishing (1988)
  7. A Michels, Micronutrients and Skin Health, Linus Pauling Institute/Oregon State University (Sep 2011)
  8. Y Shindo, E Witt, D Han, W Epstein and L Packer, Enzymic and non-enzymic antioxidants in epidermis and dermis of human skin, J Invest Dermatol 102 122-124 (1994)

(All Websites Accessed Nov 12, 2015)

Erin Madigan-Fleck

Erin Madigan-Fleck is a licensed esthetic instructor and esthetician with more than 30 years of experience in the esthetic and wellness industries. She is a nationally certified natural health professional and holds a doctorate degree in naturopathic medicine. Madigan-Fleck can be reached at