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Guest Bio:

Liz Lipski, PhD, CNS, is a pioneer in the field of integrative and functional nutrition. She is a fellow of the American College of Nutrition (FACN), holds a PhD in clinical nutrition, and holds two board certifications in clinical nutrition (CNS and BCHN), as well as one in functional medicine (IFMCP). Dr. Lipski is a distinguished lecturer and educator, and she recently retired from her position as professor and the Director of Academic Development for the graduate programs in clinical nutrition at Maryland University of Integrative Health. She has received several awards to honor her achievements and contributions in the nutrition field. Dr. Lipski is the founder of Innovative Healing, a nutrition education company, and she is a prolific writer with publications in peer-reviewed journals as well as several published books such as Digestive Wellness, Digestive Wellness for Children, and Leaky Gut Syndrome.

Transcript:

Kalea Wattles, ND:

The human body only needs small amounts of micronutrients. Yet these vitamins and minerals are vital to healthy development, disease prevention, and general wellness. Shortfalls in one or more micronutrients are commonly reported worldwide and can lead to a range of health issues, including chronic disease. In this episode of Pathways to Well-Being, we welcome a pioneer in the field of integrative and functional nutrition, Dr. Liz Lipski, to discuss the importance of micronutrients and how emphasizing these components may benefit a patient’s treatment plan while proactively optimizing overall health. Welcome to the show, Dr. Lipski!

Liz Lipski, PhD, CNS:

Hi, Kalea, you can call me Liz. It’s so nice to see you again.

Kalea Wattles:

It’s so nice to see you. And we connected a little bit about the need to maybe define micronutrients. That terminology might be new to some of our listeners, and we have to differentiate it from macronutrients. So I think we’ve agreed it’s a great place to start our show today and talk about what are micronutrients really?

Liz Lipski:

Okay, I think everybody knows about macronutrients, so the things that give us calories in our diet. So protein, fat, carbohydrates, fiber. And then we have these micronutrients, which are the vitamins and minerals. And the vitamins are categorized as fat-soluble or water-soluble, and the minerals are categorized as macronutrients, things like calcium and phosphorus that we need in multi-gram doses during the day. And then micronutrients, things that we need in just tiny amounts, like iron or zinc or vanadium or chromium.

Kalea Wattles:

Micro, that’s the key part, right? Small amounts throughout the day, like you said. Well, now that we know what micronutrients are, will you talk to us a little bit about some of their physiologic roles, all these important roles that they play in our body?

Liz Lipski:

I will. I also wanted to just mention that these micronutrients were mostly discovered, and their needs in the human physiology, were discovered over the last 100, 120 years. So this is all pretty new. And today, when I was looking at some of the research, I was really surprised that zinc was only known as a human essential nutrient in 1963 and wasn’t even added into, you know, the RDAs and the required nutrient intakes until after that. So a lot of this work is ongoing and it’s new. And because these were most of the vitamins, which essentially means essential to life, were discovered in the early 20th century, a lot of things were left out of these micronutrient categories.

So a micronutrient like CoQ10, which we know is so important for energy production, or if somebody’s on a statin, it gets depleted because the pathway is compromised, because we make small amounts of it in our own bodies, it wasn’t considered to be a vitamin. And a lot of the vitamins that we have, like B12 or B6, or thiamine or riboflavin or vitamin K or vitamin D, we do make them in our body. And so they wouldn’t have been classified as vitamins. And so I think there’s time for kind of a whole resurgence of what we think of as a micronutrient. For example, is quercetin a micronutrient? Are other bioflavonoids micronutrients? Are some of the other phenolic compounds in food micronutrients? And so there’s a huge push in the nutrition world to look at some of these other kind of unclassified micronutrients because we know there are at least 27,000 different components of food that we haven’t yet classified. And there’s a whole field called foodomics that people are looking at and going, “Huh, what are these other kind of uncategorized nutrients that are micronutrients that are really essential to life?”

Kalea Wattles:

Wow. It reminds me of how we talk about the ocean and how there’s still so much left to explore. And then all these food compounds, it’s like the ocean of nutrition.

Liz Lipski:

It is. I remember I sat with a colleague who was a molecular biologist, and he loved microscopes. And he went somewhere where they had a new electron microscope, and he said, “I’m 70 years old, and tears came to my eyes, because all of a sudden I realized there was so much I didn’t know.” And every day, I realize there’s just so much that I don’t know, that we don’t know. And that takes us back to why it’s so important to put lifestyle at the basis of health, because that’s not going to change.

Kalea Wattles:

Beautifully said. And I think we’re starting to build this case of why micronutrients are so important. They participate in all of these different body systems, but unfortunately, we know that there are many paths that might lead to micronutrient insufficiency, or even deficiency. Will you talk to us about some of those factors, and maybe some of the reasons why we have shortcomings in our micronutrient status here in the United States particularly?

Liz Lipski:

First of all, we do have deficiencies and insufficiencies. When we look at the NHANES data, the most recent nutrition data is kind of old, from 2007 to 2010, so I’m hoping that we get new updates, but when you look at that, 52% of Americans don’t have enough magnesium. Let’s see, vitamin C, almost 48%, 39% almost don’t get enough vitamin C, vitamin D, 94% of us don’t get enough vitamin D from food, vitamin E, 88%. So when we look at these foods, the insufficiency is based on government data; it’s surprising, because there’s also other big insufficiencies, like vitamin K, 66% of us don’t get enough vitamin K every day. Calcium, 44% of us don’t. Potassium, 100% of us don’t. Which is one of the reasons I think that electrolyte drinks are so popular these days, because people are getting electrolytes, they’re getting, you know, some of those missing micronutrients that they need. And also just for fluid balance and everything else.

So why is this? I think why is this is because we’re eating really differently than we used to. Our foods come from far away. I live in North America; so do you. So if we’re eating berries right now, where are they coming from? They’re coming from South America. So even if they get shipped here really quickly and come to our grocery stores, they’re still old by the time we get them. And that’s reflected in the raspberries that I buy, for example, right? Sometimes they’re only fresh for a few days after I buy them and they start to mold. So you start looking at how far our food comes from, and we’re so lucky to have this abundance of food all winter long, but it comes from far away. So it loses some nutrients, especially vitamins, as it travels.

And then the other thing is what we’re eating, because we are eating such different food. And the classifications right now are that actually, we are eating over 60%, as adults, of our food as ultra-processed foods. So when we look at what’s an ultra-processed food, there’s this food classification system globally called the NOVA food classification system. And there are four levels. So the first level is I eat an apple, right? I go out to my garden, I pick it off of the tree, and I eat that. That’s a level one food. And there’s lots of level one foods. They’re just fresh and natural, right?

We were talking before we started the call about salad. So if I make a salad at home, I’m processing that food, right? But I’m making it all of level one foods. Level two foods in the NOVA system are all the things we use to make food taste delicious, salt and herbs and spices and sugar and olive oil and avocado oil, and you know, all the little ingredients that we add that you would never sit down and say, “Oh, I’m going to have a bowl of oregano now.” But we add it to make the food more palatable, more delicious, easier to digest, it adds nutrients, it has benefits to the microbiome. There’s a million reasons why we add herbs and spices to food, why we add sugar, oil, or fat or butter or salt to food, because it just makes it taste so much better. Those are level two.

Level three is that salad that I made. I processed it, it’s a processed food, but it’s comprised of level one and two foods. So I cut up all the veggies, I take a little balsamic vinegar, a little salt, a little pepper, a little olive oil, done. I’ve got a processed food, level three, but it’s just the way nature intended it for me to eat it.

If I go and buy a salad, used to be able to buy salads in cans, now just canning, it has to destroy a lot, because of the process of heat. And when we go, for example, to the deli section of a grocery store and we buy a broccoli salad there, or one of the salads that look delicious, those come in big buckets, and they’re loaded with preservatives. And if you look at the quality of the oils and fats that are in them, they’re probably not that great. And those are level four foods, even though they look like they’re just vegetables, because they’re highly processed, and they’re made with ingredients that aren’t the ingredients that we would normally use if we were making it in our home kitchen. And people are living on chips and pizza and noodles and refined foods.

So when we look at that, that over 60% of our foods are high in sugar and white flour and have maybe coloring and preservatives and other additives in them, then we’re missing a lot, because every time we make a food more fun, in a way, through food science, and we make it more addictive, we add sugar, salt, and fat to it, and we strip out nutrients. So even, for example, when we buy, oh, just a regular cooking oil from the grocery store shelves, they used to have antioxidants and vitamins and some minerals in them. To make them more shelf stable, they get processed so that all those vitamins that may be able to make it go bad are pulled out, all the antioxidants are pulled out, and then we add preservatives. So those oils aren’t even like high quality oils anymore. But if we buy organic oils that are cold processed or that are just pressed oils, then those retain all those nutrients.

And so we know that that’s where a lot of the stripping of the minerals and the vitamins comes from, is in the processing of food itself. And our kids and teenagers are eating more than two-thirds of their foods as these ultra-processed foods. What we know about the ultra-processed foods is that they also increase diabetes, stroke, heart attacks, Alzheimer’s, and various types of cancers. They shorten our lifespan. And I’m kind of fascinated with the research on these ultra-processed foods, because the more we learn about them, the worse we realize they are for us. So kind of in a nutshell, what we are right now is we are overfed and we are undernourished in our culture, in most cases. And that undernourishment is a lot on a micronutrient level.

Kalea Wattles:

Yeah, and I think we should explore that a little bit, but as I’m listening to you, it made me realize how nuanced this conversation about processing is. I was just thinking of my own life and how we have an apple orchard here, and I’ll go, you know, pick the apples, and then we make apple sauce, and we put them in our slow cooker and we add cinnamon and nutmeg, and I am processing those foods, but in a way that it’s still that whole ingredient. And it’s making me feel more mindful of how I talk about nutrition and processing and how some processing can still be healthful. We have to look at it in the context of that whole food environment and where it came from. So thank you for giving us those levels. It was such a good food for thought there. Now you mentioned how sometimes these insufficiencies can translate into different disease states, and you’ve loved reading research about that because it’s so fascinating. Will you talk to us a little bit of how we may even see single micronutrient deficiencies or, you know, a combination of deficiencies, how that might manifest in a human body, what that looks like?

Liz Lipski:

Okay, I love this question, because each of the micronutrients has a personality. They have different functions in the body. And so, for example, you can look at the B vitamins, right? One of the first signs of micronutrient deficiency is that people feel tired and that people feel bummed out. They feel depressed, they feel anxious. And long before we see kind of bigger nutrient deficiencies, we often see mental health deficiencies and energy deficiencies. So sometimes I’ll think, oh, somebody’s tired and they’re depressed and they’re irritable. And I start thinking, I wonder if they have a B vitamin deficiency. So then I might look at, do they have little cracks here? Do they have little broken blood vessels? If I look at their tongue, are there cracks in their tongue? All these things let me know that somebody has maybe a need for more B vitamins. And when we look at B vitamin need from a genetic level, we know that at least 50% of us have methylation insufficiencies, and those methyl groups require folate and thiamine and B6, B12. And so we know that for methylation, we need a lot of B vitamins too. So when I look at somebody’s family history and I see a lot of mental health issues, I see a lot of cancers, then I start thinking, oh, this person comes from a family with methylation issues. They might have a greater need for those B vitamins than someone else, right?

So just in a snapshot, that’s like a little bit about B vitamins, but look at magnesium, that 52% of us aren’t getting enough magnesium, because magnesium is refined out of our flours. And also, we find a lot in meat, we find a lot in green leafy vegetables. And a lot of people aren’t eating very many vegetables to begin with, and they’re not eating whole grains that still have magnesium. So a picture of magnesium that I see quite often, or I saw quite often when I was in practice, is somebody would be saying, “You know, I’m very irritable, I cry easily, I tend to be constipated. I’m very sensitive to noise. If somebody’s mowing the lawn or somebody’s watching TV or playing music loudly, that really bothers me. Sometimes I get menstrual cramps, if I’m a woman. I can get cramping in my body if I’m anyone. And sometimes I get these little things, I call pings, which is just like, there’s just like this little zip that goes in, like a nerve just zips. And sometimes my eyelids, they just flutter. They have like little twitches in them.” All of these are signs to me that somebody’s magnesium insufficient.

For vitamin C, I think of things like bruise easily, get every cold and flu that comes around, teeth bleed when I floss. You know, some things like that. And so when you start knowing the nutrients, then you can start looking and saying, oh. Or somebody says, “You know, my night vision’s not that great.” And you start thinking, oh, vitamin A. Well, does your skin feel dry? Does it have little bumps on it? Maybe you need more vitamin A. And so you start putting together these kind of nutrition-focused physicals. And as you start understanding each micronutrient and its personality, then you can start playing with that and asking people to increase those nutrients in their diet and or maybe even take a supplement that has one. I’m a big fan of multivitamins. I think we can do a lot. When you look at that list of all the insufficiencies and deficiencies that the government tells us we have, we can do quite a lot with just a multivitamin with minerals every day.

Kalea Wattles:

And for all the reasons you mentioned, it can be challenging to meet all of our nutritional needs. So the vitamin helps us to fill those gaps, right?

Liz Lipski:

It does, yeah. You know, when I was younger, I used to sit down and I would calculate out everybody’s nutritional needs based on what they showed me, that, you know, their food diaries. And there was no one, including me, that met every single nutrient need. For example, vitamin D. It’s really hard to meet it, which is one of the reasons why we add it to dairy products. Vitamin E, also really hard to meet the minimum requirements for vitamin E, because they’re in nuts and seeds. And how many nuts and seeds are people eating? The average person’s eating less than one pound a year of nuts, and most of those are in pastries.

Kalea Wattles:

Yeah, that makes sense. Well, I’m thinking of when I’m with patients and I notice that they have some kind of insufficiency, whether, you know, it’s on, maybe I do some lab testing and I find that they have low iron or low B12, and then I’m asking myself this question, is it because you don’t like food sources of these nutrients? Is that the problem? Or is it that you’re eating those foods and you like them, but your absorption is poor? Or is it that all of those things are fine, but your sources are just so deplete because of the soil that they’re growing in? Or you know, all of these factors we’ve talked about. How do you tease that apart? Is history collection your most powerful tool? Is it just getting to know the patient and doing a dietary recall? Tell us your pro tip for how you get to the root of some of these things.

Liz Lipski:

I think because people eat so terribly, even though when you ask somebody, tell me about your diet, and they say, “I eat pretty well.” I have heard that so many times. And what I know is that people think they eat well, but we don’t really eat that well. And so I always begin with a food diary. What are you eating? How frequently are you eating? What are your patterns of eating? And really look at that, and then look to see where they’re getting those micronutrients.

And then IFM, in our toolkit, we have such great handouts on every single nutrient, the food sources, so that you can give those to your patients and just say, “Okay, let’s try to find three foods on this list that you like, and let’s kind of not just focus on three, but three this week and next week find three more, and try to stretch what you’re eating a little bit.” Because I think food is really where we’re supposed to be getting these nutrients. Yes, our soils are deplete. We know that organic foods have more micronutrients in them than commercially grown foods. The foods that we grow in our yards and we pick fresh have more micronutrients and especially more of those polyphenols. But even the best diet doesn’t necessarily mean that we’re absorbing all of those nutrients.

So then we start looking at digestive function, and you know, I’m really interested in digestion. And so with digestive function, is somebody able to absorb their food and digest it? So do they have leaky gut? If they have leaky gut, they’re probably absorbing undigested food molecules. At the same time, they may also have malabsorption, in which case they’re not absorbing all the nutrients that are in the food. So if, like, for example, if somebody has diarrhea, you know that they’re not absorbing all the nutrients, because the chyme hasn’t spent enough time in the body for everything to be absorbed into the small and large intestine. Some people, as we age especially, don’t have enough pancreatic enzymes or don’t have enough gastric acid in the stomach to start breaking down proteins. And also for minerals, that gastric acid is really important because we need it to absorb things like iron and calcium. You know, how many times have you told somebody, “Oh, to get better absorption of your iron, drink it with some orange juice or tomato juice, because we need that acid.” So if somebody doesn’t have enough gastric acid, which can happen from aging or stress or taking PPIs, then we’re affecting mineral absorption. So then we start looking at digestion.

So those are my two main prongs would be looking at what someone’s eating, try to support them in eating more trace minerals and more vitamins, especially the ones that they need. And then to start looking at digestive function. Do they need enzymes? Do they need bitters? Do they need betaine HCL support? Do they have leaky gut? Do they have dysbiosis? And so we move forward in all of that to try to enhance digestion so that there’s better absorption of nutrients.

Kalea Wattles:

These are such juicy questions that we have to answer with this type of clinical scenario. So I’m wondering, you mentioned how you’ll do a nutrition-oriented physical exam, that you know and can identify the signs and symptoms of nutrient insufficiency. So you’ll build that into your intake. Beyond those questions and physical exam, are you doing a comprehensive stool analysis to look at digestive function? Are you doing some kind of advanced micronutrient analysis, either in the blood or in the urine? Will you talk us through some of those tools that you’re using for assessment?

Liz Lipski:

Sure. Well, first of all, I’m not in practice anymore. I’m doing education only after over 30 years in practice. It seemed like my life took a turn. But yes, I have used all of these things. So, for example, if somebody is really run down, they have autoimmune conditions, they have been ill for a long time, if I suspect nutrient insufficiencies, I will send them back to their own physician or clinician and say, “Please run the following tests.” I think that we can run quite a lot of nutrient testing through regular labs. Through conventional labs, it can go through insurance. People don’t have to pay out of pocket for it necessarily.

So for example, I remember once I was working with a woman who, her vitamin 25-OH D levels were chronically low. She was working with an endocrinologist. She had what I call mystery illness. She hadn’t been diagnosed with any specific autoimmune condition, but it certainly felt like she had one that was just waiting to be named. And she had been on high doses of vitamin D, 10,000 units a day for over a year, and her vitamin D levels were still below 20. And I said, you know, “Just ask her to check your retinol levels, your vitamin A levels.” And the doctor checked not only her retinol levels but also her carotene levels. Her carotene was fine, but her vitamin A levels were extremely low. So when we supplemented her with 10,000 IUs of vitamin A every day, within three months, her vitamin D levels came up. The fat-soluble vitamins work together. The microbiome makes most of the vitamin K. When we eat fermented and cultured foods, we get vitamin K, which is essential to bones and immunity. And so I wasn’t so worried about vitamin K levels because we could address that with food. But the vitamin A, I felt like we really needed. And that worked for her.

Just recently, I asked my own doctor, I said, “Run a methylmalonic acid and a riboflavin and a B6 and a thiamine and red blood cell zinc level, and vitamin D. Let’s just kind of do a quick look at my levels.” And Medicare paid for all of those tests, right? So looking at that. So I think first, to use the systems that we have and use the tests that we have. There are good micronutrient arrays that can be run. Copper, zinc, magnesium. There’s lots that we can do within regular testing. That said, I love running some of the Genova Diagnostics tests. My favorite is the NutrEval. And I love it because it shows me not only about micronutrients, it shows me about antioxidants, it shows me organic acid levels, fatty acid levels and types of fatty acids, organic acids from urine, which are metabolites that can tell us about how well we’re detoxifying, give us some information about whether we might have some dysbiosis. There’s so much information in there that we could use. So I really love that test. And they have less expensive kind of arrays that don’t have all of that information. But I figure if I’m going to do one nutritional test, I want the best one. I think SpectraCell also has really great micronutrient analysis, and I’ve used them also quite a lot. They also measure CoQ10 levels and measure antioxidant status. And so I think that there are definitely times where we’re going to want to know, and I don’t know about you, but almost every single person, maybe every person I’ve ever tested, there’s something that they have higher nutritional needs for than is shown in their labs.

Kalea Wattles:

Yes, I wholeheartedly agree. And I joke about this story sometimes that I did a NutrEval on myself my first year in practice out of school. You know, I have a nutrition degree, I was eating healthy. But there is this differentiation between intake and what you’re actually absorbing, right? Because I was so stressed, eating in front of the computer, eating while I was charting, and even though I was taking in healthy foods, that was one of the worst test results I’ve ever seen on my own. So they’re definitely, we have to consider all the factors that allow us to assimilate and utilize those nutrients as well.

Liz Lipski:

Yeah, it’s so funny. I know, for example, I always need more magnesium and my body craves green leafy vegetables and folate. My body just craves it way more than somebody else. And then when I did my methylation pathways, sure enough, you know, I have a heterozygous methylation need that’s greater than some other people. And it shows up in my cravings of needing green things every day, which I think everybody should eat green things every day. But you know, it’s like starting to know and understand, just like you know when you’re thirsty, understanding what micronutrients you might be needing is kind of an interesting pattern to look at.

Kalea Wattles:

Wow. A whole new layer of body awareness to pay attention to these types of things. And before we move on, I know you love talking about the gut, and I love listening to you teach about the gut, and you mentioned leaky gut or intestinal permeability. And I wanted to spend just a few minutes and talk about the relationship between an increased permeability and our micronutrients. So are there some micronutrient deficiencies that might set the scene to have a more leaky gut barrier?

Liz Lipski:

There are a couple that I think of. One would be vitamin A. You know, I’ve given a lecture called vitamin A can’t get no respect, because we’re all afraid of vitamin A because of some of the research on vitamin A, for example, with smokers giving vitamin A seemed to increase risk. Was that the vitamin A’s fault or not? We don’t want to talk about that. But anyway, or in pregnant women. But I had a couple of doctoral students who did a really good review paper for me that demonstrated that at levels of 10,000 units a day, vitamin A were pretty safe for almost everyone. And I remember some of my mentors, Jonathan Wright and Alan Gaby in their training, their nutrition training, they would sometimes use really high levels of vitamin A when people were getting ill with viruses, sometimes, you know, 100,000 units a day or more of vitamin A, or women who were having really extensive menses that were having, you know, lots of heavy bleeding using for a period of two to three months, high-dose vitamin A. And in practice, I was able to do that. So anyway, leaky gut, we think of vitamin A, it’s so important for mucus membranes, and the intestines are mucus membranes. So vitamin A. The other nutrient micronutrient that I think of that’s so critically important would be zinc. And we know that zinc’s important for the health of the entire GI tract. So, for example, if somebody has GERD or esophagitis, we’ll often recommend zinc carnosine or any kind of zinc. Same thing for leaky gut. There’s often zinc in the mix of nutrients that we give. So those are two nutrients that I think of for leaky gut.

Kalea Wattles:

I think I’m remembering you’ve done a food demo before in the past where you made, I think we called it a better butter, and it had some zinc in it and all of these great things to support that healthy barrier. And I just love the idea of butter as medicine.

Liz Lipski:

Yeah, I make my own ghee, which is so easy to do. That’s another demonstration that I’ve done for IFM many times in the GI module. And ghee in Ayurvedic medicine has been used for millennia to deliver all kinds of nutrients. And that better butter had zinc and vitamin A and colostrum and I think some glutamine in it.

Kalea Wattles:

That’s what I’m remembering. And sometimes when people tell me they don’t like vegetables, I say, “Have you tried butter or ghee?” Right, and going back to the beginning of our conversation about processing and the things that we add to our foods to make them more palatable and more exciting, something like ghee that just came to me, how wonderful of an addition that can be in your processing.

Liz Lipski:

And some people love coconut oil or adding tahini to a salad dressing, or just to dribble a little bit on vegetables. You know, find what makes them taste great to you.

Kalea Wattles:

Yeah, so important. We could have a whole episode about finding joy in our food, but I promise I’ll keep us on track and ask my next question for you, because we often talk about, you know, the DASH diet or the Mediterranean diet or these food plans that we know have benefit for insulin resistance and glucose control and cardiovascular disease. Are there some specific parts of these diets that might help us to maximize our micronutrient intake as well?

Liz Lipski:

I’m not sure that there are. I think that when we look at the diets, it’s the whole diet, because they’re well-balanced food plans. So the Mediterranean diet, we have more research on that one type of diet than any other diet in the world. But I think that if we looked at a traditional Kenyan diet, or we looked at a traditional Indian diet or Japanese diet, that we would find that eating a traditional diet from anywhere in the world is going to supply all the nutrients that you need. And the reason for this is if it didn’t, people would have died. For example, if you have no zinc, you’re dead, you have no vitamin A, you’re dead, you have no B12, you’re dead. So the fact that people thrived in all these cultures says that they were pretty nutrient rich.

And so when we look at the Mediterranean diet, and I looked at some of the research, the reviews are, yeah, you can get, you know, pretty much all of your minerals and almost all of your vitamins, but you’re not going to get that vitamin D, which you need from the sun, you’re not going to get enough vitamin E, probably, unless you eat a lot of nuts and seeds. And so, you know, even in the best diets, we still have to pay attention a little bit. But what I love is that all of our diets that were created for our food plans, they all started out with a Mediterranean diet, which we called the Core Food Plan. And then we adapted those for whether you need more energy or you need to detox or you have metabolic syndrome or you have diabetes, or we adapted those to make those more specific food plans. But they all started with the Mediterranean diet.

Kalea Wattles:

Yeah, okay. So I see there’s pillars of a healthy eating plan, and then we can customize that and personalize that based on your preferences and your blood work and your goals. And that’s how we create this precision nutrition plan.

Liz Lipski:

Correct.

Kalea Wattles:

So I’ll be forthcoming that when I track my nutrients, sometimes it’s very easy for me to get obsessed about trying to meet, you know, every day get all of these different micronutrients. And as we’ve talked about, it’s really, really hard. Do you have some advice, or can you give us peace of mind for anyone like me who might be chasing this micronutrient sufficiency every day? And what I’m hoping you’ll say is that if we’re meeting these goals, you know, some days of the week, that overall we’ll find balance and that we don’t have to get 100% of every nutrient on every day to have longevity and freedom in our health.

Liz Lipski:

You just said it.

Kalea Wattles:

Okay, great.

Liz Lipski:

Stop obsessing about it. So for example, let’s say that you eat oysters one day, right? You go out or you bring them home and you eat cooked or oysters on the half shell, right? You just had a couple hundred milligrams of zinc. So if you don’t get a lot of zinc the next few days, or even the next week, so what? It all balances out. And so you know, not to obsess about it. And then on the other hand, if you see sometimes if you are using a food tracker and you’re watching and you’re going, “Whoa, I got 180% of this nutrient, did I need that much?” Again, most of it’s water-soluble, and it’s going to wash, a lot of it’s water-soluble. And as far as our fat-soluble vitamins and our A, D, E, and K and our minerals, I like to think of them as getting banked. We have bank accounts, and so we put those in, and when we need them, we have storage. So for example, in our liver alone, we have three to five years of B12, if we have adequate stores. Vitamin A, we have adequate stores, zinc, you know. So I’m not obsessed with kind of what we do every day. I’m more interested in how we feel every day.

Kalea Wattles:

Very relieving to hear you say this. And you know, my patient population is mostly fertility. And so then I’ll get pregnant mamas and they’ll miss a day of their prenatal vitamin because they’re so nauseous, and they’ll feel so guilty. And we have this conversation that your body is resilient and dynamic, and it’s about the choices we make most days and not about what happens on any one given meal.

Liz Lipski:

Yeah.

Kalea Wattles:

Wonderful. Well, what a relief, and hearing it from you is just the ultimate. So Liz, as we wrap up our time together today, are there any other gems or clinical pearls that you would like functional medicine clinicians to take away from this conversation, in terms of micronutrients and therapeutic food plans and identifying some insufficiencies in their patients?

Liz Lipski:

Well, the first thing is to think about food, to think about the base of the functional medicine tree and to actually have people come in at a first visit or a second visit with a three-day food diary or a week-long food diary and an exercise and sleep journal and start there. I think it’s so critically important. And if it’s not part of an initial intake, why? So put it in your initial intake. The second thing is to start learning about the qualities of these micronutrients so that you can start recognizing them. Michael Stone did such an amazing nutrition-focused physical exam course. So taking pieces of that and starting to think about those micronutrients. The Linus Pauling Institute has a lot on micronutrients, so just starting to look at those things. And I think the final thing would be if you don’t have a dietitian or nutritionist or nutrition coach working in your office, to think about having one. When I ask physicians about what have been the benefits of adding somebody who really understands nutrition into their practice, they start telling me these long lists. They can’t imagine after a while how they functioned without it. And I think that when you get one of us in your practice, it changes the way you practice medicine.

Kalea Wattles:

So to summarize, it’s get to know your nutrients and be able to have some pattern recognition skills, build a collaborative care team, and be willing to ask the questions and to remain curious about someone’s relationship with food. Wonderful.

Liz Lipski:

Yeah. The relationship with food leads us into also disordered eating and eating disorders, but that’s a topic for a whole ‘nother day.

Kalea Wattles:

Yes, indeed. Well, Liz, thank you so much for spending time with us and for sharing these clinical insights and your love for nutrition and gut health. It’s just so fun to chat with you about it, and we so appreciate your time today.

Liz Lipski:

Thanks, Dr. Kalea.

Kalea: Discover the latest research and innovative clinical practices at IFM’s Annual International Conference, May 29 through June 1, 2024, at the Bellagio in Las Vegas. For more information, visit aic.ifm.org.