"...all doctors should be able to diagnose and treat nutritional deficiencies."

Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002

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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


Copyright Dr. Alan Stewart M.B.B.S.M.R.C.P. (UK)M.F. Hom.
47 Priory Street, Lewes, East Sussex. BN7 1HJ
Tel 01273 487003 Fax: 01273 487576