"...all doctors should be able to diagnose and treat nutritional deficiencies."
Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002
This page has been printed from the www.stewartnutrition.co.uk web site.
Deficiency Symptoms and Signs
Symptom or Sign |
Possible Nutritional Deficiency |
Other Possible Causes |
| General Symptoms and Appearance | ||
| Fatigue | Protein-energy, iron, magnesium, potassium, vitamins B1, B12 and other B vitamins and vitamin C | Many physical illnesses including hypothyroidism, cardiac failure, anaemia, chronic fatigue syndrome and depression |
| Loss of appetite | Zinc | Many chronic illnesses |
| Pica eating non-nutritive substances | General malnutrition and possibly iron, calcium, zinc, vitamins B1 – thiamine, B3 – niacin, C and D | Normal in infants under 2 years of age, pregnancy especially in young women, mental illness |
| Loss of taste | Zinc | Common cold, many nasal disorders |
| Cold intolerance | Iron | Hypothyroidism, anaemia and reduced cardiac output |
| Pale appearance due to anaemia | Iron, folate and vitamin B12 | Excessive bleeding and haematological disorders |
| Carotenoderma – yellow discolouration of the skin noticeable on the face and trunk | Protein-energy and zinc | Dietary carotenoid excess especially in women, hypothyroidism |
| Diffuse hyperpigmentation | Protein-energy | Addison’s disease and haemochromatosis |
| Muscle wasting e.g. clothes appear too big, loss of limb musculature | Protein-energy | |
| Loss of height and excessive curvature of the spine | Calcium and vitamin D | Increasing age and disease- related osteoporosis |
| Skin | ||
| Itchy skin – pruritus | Iron | Many skin diseases, liver disease |
| Dry skin | Essential Fatty Acids or multiple nutritional deficiencies | Old age, skin conditions e.g. eczema |
| Red scaly skin in light-exposed areas | Vitamin B3 | Excessive sun-exposure in red/fair haired individuals light-exposed areas |
| Excessive bruising | Vitamin C | Old age, trauma and blood disorders |
| Haemorrhage or redness around hair follicles | Vitamin C | |
| Bleeding into a joint or other unusual bleeding | Vitamin C | Various blood disorders |
| Plugging of hair follicles with keratin or coiled hairs | Vitamin C | |
| Fine downy hair on torso – lanugo | Protein-energy. Typical of Persistent anorexia nervosa | |
| Mouth | ||
| Sore tongue | Iron, vitamin B12, B2, B3 and possibly other B vitamins | Excessively hot drinks and oral disease |
| Cracking and peeling of skin on the lips | Vitamin B2 – riboflavin | Excessive exposure to cold or windy weather |
| Cracking at the corners of the mouth | Iron, vitamin B2 – riboflavin possibly other B vitamins | Poorly fitting dentures, eczema infection with candida albicans |
| Recurrent mouth ulcers | Iron, vitamin B12, folate and possibly other B vitamins | Coeliac disease, Crohn’s disease recurrent herpes and oral disease |
| Enlarged veins under the tongue with micro-haemorrhages | Vitamin C | Smoking and old age |
| Smooth, shinny and sore tongue: atrophic glossitis | Iron, vitamin B12 and folate | |
| Head, Face and Neck | ||
| Scalp hair loss | Iron | Any scalp disease, alopecia from other causes |
| Dandruff | Essential fatty acids and biotin | Fungal infection of scalp |
| Redness at the sides of the nose | Vitamin B2 –riboflavin, vitamin B6 and zinc | Seborrhoeic dermatitis |
| Redness or cracking at the outer angle of the eyes | Vitamins B2 or B6 | |
| Goitre | Iodine deficiency is likely if goitre is present in > 20% of population – endemic goitre | Adolescence, pregnancy and various forms of thyroid disease |
| Hands and Nails | ||
| Nails - brittle or flaking | Iron and possibly essential fatty acids | Poor circulation and old age |
| Nails - upturned or spoon-shaped nails | Iron | Psoriasis or other diseases of the nail bed |
| Carotenoderma – yellow discolouration of the skin noticeable on the palms | Protein-energy and zinc | Dietary carotenoid excess especially in women, hypothyroidism |
| Musculo-skeletal | ||
| Muscle pains and cramps | Magnesium, potassium, sodium, vitamin B1 and vitamin D if there is hypocalcaemia | Muscle or neurological disease, polymyalgia rheumatica and hypocalcaemia |
| Calf muscle pain after minimal exercise | Vitamin B1 – thiamine | Torn muscle, peripheral vascular disease and myopathy |
| Excessive calf muscle tenderness | Vitamin B1- thiamine | Torn muscle, thrombosis |
| Walking with a waddling gait | Vitamin D and resultant myopathy | Osteoarthritis of the hips or disease of the hip-girdle muscles |
| Difficulty getting up from a low chair or climbing the stairs or weakness of shoulder muscles | Vitamin D and resultant myopathy | Arthritis of the hips or knees, diseases of the nerves or muscles |
| Bowed legs | Vitamin D - rickets in childhood | Paget’s disease and syphilis |
| Twitching of facial muscles when tapping on the facial nerve in front of the ear: Chvostek’s sign | Calcium and vitamin D if hypocalcaemia or severe magnesium deficiency | Hypocalcaemia for other reasons e.g. hypoparathyroidism |
| Eyes | ||
| Poor night vision | Zinc, vitamin A and possibly vitamin B2 - riboflavin | Retinal disease |
| Conjunctival dryness | Vitamin A | Old age and Sjogren’s syndrome |
| Gastrointestinal | ||
| Diarrhoea | Vitamin B3 | Irritable bowel syndrome, malabsorption, infective diarrhoea and many other causes |
| Constipation | Dehydration, fibre, potassium, magnesium and folate | Irritable bowel syndrome, diverticulosis, cancer of the colon |
| Neurological | ||
| Restless legs | Iron or folate | Various neurological disorders, pregnancy, rheumatoid arthritis, and renal failure |
| Burning feet syndrome | Vitamin B2 –riboflavin | Early peripheral neuropathy |
| Loss of balance when standing upright with feet together and the eyes closed: Romberg’s test | Vitamin B12 and possibly vitamin B3 | Many neurological disorders affecting the cerebellum, spinal chord or peripheral nerves |
| Loss of vibration sensation in the lower limbs | Vitamin B12 and possibly vitamin B3 | Increasing age and peripheral neuropathy |
| Peripheral neuropathy – numbness, tingling, disordered sensation, pain and or weakness in the hands or feet | Vitamins B1, B12 and possibly B3, B6 and folate and very rarely copper (following gastrointestinal surgery or excess zinc ingestion). Relative lack of essential fatty acids. | Diabetes and many other causes |
| Unsteady movement or walking (cerebellar ataxia) | Vitamin B1, vitamin E and Coenzyme Q10 | Alcohol, hypothyroidism and many neurological and inherited disorders |
| Mental State | ||
| Depression | Vitamins C, B1, B3, B6, B12, folate, biotin and possibly the essential fatty acids | Mental illness, stress and as a consequence of physical illness |
| Irritability | Folate | Alcoholism, deprcssion and personality disorder |
| Poor concentration | Iron, vitamins B1, B12, folate and possibly essential fatty acids | Depression, stress, lack of sleep, alcohol, dementia, anaemia, hypothyroidism and many other diseases |
| Cardio-vascular | ||
| Heart failure | Vitamin B1 – thiamin and any deficiency causing anaemia | Coronary, valvular and myocardial disease |
| Palpitations | Potassium and magnesium and any deficiency causing anaemia | Coronary, valvular and myocardial disease |
