Q: How do I find out my nutritional status? Articles commonly recommend assessing one's nutritional status or discovering one's deficiencies. They never say how this is achieved. No doctor I know has a way of finding this out. B.P., Sherborne.
A: Doctors with a nutritional bent use one of two approaches (or a combination of the two) to determine your nutritional health: a detailed questionnaire or a barrage of tests. The best combine both approaches.Any doctor worth his prescription pad will have you fill out a detailed questionnaire (often prior to your arrival in his office) asking questions about not only your own health history but that of your family members, even your grandparents. These questions would include information about allergies, illnesses and reasons for death.
He or she will also need to do an in depth report on your lifestyle. One British doctor we know of asks his patients to note down, in great detail, what they tend to eat in a typical week. Increasingly, many doctors, generally referred to as "clinical ecologists", also will ask for information about your home, your type of work and work environment, and your hobbies, as many building materials or chemicals involved in certain offices or work sites have been shown to adversely affect health.
This doctor will probably ask questions about the kind of work you do and under what kinds of conditions (happy or unhappy, say), as stress of any sort tends to be a chief source of nutritional deficiency and illness. He may also devise a questionnaire to determine if you have any allergies, which can affect your ability to absorb certain minerals. And of course he'll want to know about whether (and how often) you indulge in social poisons like alcohol or tobacco or even so called recreational drugs. If you are of childbearing age, he'll probably need to know what sort of contraception you are using.
If any allergies are suspected, he may perform a "prick" test on you or, more conclusively, place you on a rotation or elimination diet (sometimes called the "Stone Age Diet") which will help to pinpoint which, if any foods, you may be allergic to. Nutritional Medicine, mentioned in the previous question, offers a simple guide to a rotation diet, as does The Allergy Handbook by Dr Keith Mumby (Thorsons, lb3.99).
Finally, he may ask a number of questions designed to determine if you have any deficiencies. For instance, recurrent mouth ulcers could indicate a deficiency in iron, vitamin Bl2 or folic acid; brittle or split nails, a deficiency in zinc, iron or essential fatty acids. (Of course, these symptoms could be caused by other medical conditions, which is why it's important to discuss them with a skilled practitioner.) For a rough guide to nutritional deficiencies, see either Nutritional Medicine or Food Allergy and Intolerance by Jonathan Brostoff and Linda Gamlin (Bloomsbury, lb4.99).
Because certain clinical signs can signal one of a number of problems, several practitioners in the UK and America have begun to use a variety of laboratory tests which they believe provide them with an accurate nutritional profile. These include sweat tests, which tests for mineral levels, particularly zinc, which is often deficient in many people these days. Blood tests can determine whether you have a B6 deficiency, can test for your zinc and copper levels and can determine your iron status. And finally there is the controversial hair analysis test, which proponents say is an accurate snapshot of your nutritional mineral status a few months before (when the hair sample grew out of the scalp) and its detractors say is an inaccurate and expensive waste of time.
Unfortunately, only one laboratory we know of conducts the sweat tests in the UK (Biolab), although numerous laboratories will conduct hair analysis. If your own doctor is sympathetic to your wish to have yourself nutritionally checked out, we suggest he contact the British Society for Nutritional Medicine (PO Box 3AP, London WlA 3AP) or The Nutrition Society (Chandos House, 2 Queen Anne Street, London WlN 9LE; tel: 07l 580 5753) for recommendations on how to go about it. Alternatively, he can contact Foresight for further information about whether and how to conduct any tests you'd like done.
Unfortunately, too many doctors tend to be "flat-earthers", as Stephen Davies once wrote, when it comes to nutrition. And not surprisingly, most NHS doctors faced with an average of seven minutes per patient, haven't the time to conduct this kind of comprehensive work up on each patient. If you can find a local doctor open minded enough to consider nutrition an important medical consideration, you might refer him to Nutritional Medicine, which offers a goodly list of references of published scientific papers supporting its conclusions.