Why Am I Nutritionally Deficient Despite Eating Regular Meals?

Eating three meals a day but still experiencing malnutrition?

Hello, doctor! I am 157 cm tall and weigh 50 kg.
I would like to ask, if I normally eat three meals a day, for example: (Breakfast: tuna egg toast, milk tea) (Lunch: two vegetables, tofu or eggs, meat, white rice, a box of fruit) (Dinner: dark leafy greens, lean meat, tofu, a small amount of rice), and drink 1500 cc of water daily, why do I still have symptoms of malnutrition such as dents and white spots on my nails? I thought it might be a gastrointestinal issue, but I have regular bowel movements every day and my condition seems fine! What could be the problem? Should I get checked? Thank you!

ANAN, 20~29 year old female. Ask Date: 2017/07/25

Dr. Cai Xiuwen reply Nutrition

Hello, spoon-shaped nails are commonly seen in clinical practice and are often associated with iron deficiency anemia.
Women may experience anemia more frequently after their menstrual period.
It is recommended to supplement with foods that are high in heme iron, such as beef, lamb, pork blood, and rice pudding made with blood.
If symptoms do not improve, it is advisable to visit a clinic for a physician to check for any other related issues.
This information is provided by Dietitian Tsai Hsiu-Wen from Nantou Hospital, Ministry of Health and Welfare.

Reply Date: 2017/07/25

More Info

It sounds like you're doing a commendable job of maintaining a regular meal schedule, but you're still experiencing signs of nutritional deficiency, such as the appearance of your nails. This can be perplexing, especially when you feel like you're eating a balanced diet. Let's explore some potential reasons for your situation and what steps you can take to address it.

Firstly, while your meals seem to include a variety of food groups, it's essential to consider the overall quality and quantity of the nutrients you're consuming. Nutritional deficiencies can occur even when eating regular meals if those meals lack certain essential nutrients. For instance, if your diet is low in specific vitamins and minerals, such as iron, calcium, vitamin D, or B vitamins, you may experience symptoms like nail changes, fatigue, or weakness.

Your meals include protein sources like tuna, eggs, and tofu, which are great for muscle maintenance and overall health. However, it's crucial to ensure that you're getting enough of these proteins and that they are complemented by a variety of vegetables and whole grains. The types of vegetables you consume can also impact your nutrient intake. Dark leafy greens, for example, are rich in iron and calcium, while colorful vegetables provide a range of vitamins and antioxidants.

Another factor to consider is the portion sizes of your meals. While you may be eating three meals a day, if the portion sizes are too small or if you're not including enough variety, you might not be meeting your nutritional needs. It's also worth noting that some individuals may have higher nutritional requirements due to factors like physical activity levels, metabolic rate, or specific health conditions.

Additionally, the way food is prepared can affect nutrient absorption. For example, cooking methods that involve boiling can lead to the loss of water-soluble vitamins. If you're primarily consuming cooked vegetables, consider incorporating some raw options or using steaming methods to preserve nutrients.

You mentioned that you have regular bowel movements, which is a positive sign of digestive health. However, if you suspect that there might be underlying gastrointestinal issues affecting nutrient absorption, it could be beneficial to consult with a healthcare professional. Conditions like celiac disease, Crohn's disease, or other malabsorption syndromes can lead to nutritional deficiencies despite a seemingly adequate diet.

Given your symptoms, it would be wise to consider a few steps:
1. Consult a Nutritionist or Dietitian: A registered dietitian can help assess your dietary intake more thoroughly and identify any gaps in your nutrition. They can also provide personalized recommendations based on your specific needs.

2. Consider Nutritional Testing: Blood tests can help identify deficiencies in specific vitamins and minerals. This can provide a clearer picture of your nutritional status and guide any necessary dietary adjustments or supplementation.

3. Evaluate Your Diet: Keep a food diary for a week to track everything you eat and drink. This can help you and your healthcare provider identify patterns or deficiencies that may not be immediately apparent.

4. Diversify Your Diet: Aim to include a wider variety of foods in your meals. Experiment with different fruits, vegetables, whole grains, and protein sources to ensure you're getting a broad spectrum of nutrients.

5. Stay Hydrated: While you mentioned drinking 1500cc of water daily, ensure that you're also consuming foods with high water content, such as fruits and vegetables, which can contribute to overall hydration and nutrient intake.

In conclusion, while you are making efforts to eat regular meals, there may be underlying factors contributing to your nutritional deficiencies. A comprehensive evaluation of your diet, along with professional guidance, can help you identify and address these issues effectively. Remember, nutrition is a complex field, and individual needs can vary widely, so personalized advice is often the most beneficial approach.

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