Hidden Hunger, Peripheral Neuropathy, and Cancer

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Hidden hunger is described as deficiency in micronutrients despite sufficient energy consumption.¹ Such hidden hunger is frighteningly common across the world, even in developed countries, such as the Federal Republic of Germany and the People's Republic of China.^2–4 The term "hidden hunger" derives from the fact, that our bodies don't seem to have the mechanisms to detect these micronutrient deficiencies, unless we develop serious ailments caused by them. This of course does make it quite difficult to ascertain just how many people around the world are afflicted by it.

It's kind of self-explanatory, that nutrient deficiencies are unhealthy, but what exactly is the problem with hidden hunger, why does it happen, and how does it pertain to cancer care? These questions we'll tackle in this article.

Nutrient Deficiency

Before we get into the discussion of these three questions, I want to take a bit of time to understand exactly what constitutes a nutrients deficiency and what doesn't. Reason for this is the disturbing trend of assigning nutrient deficiency to individuals, based solely on the amount of raw nutrients consumed.

This seems like a reasonable thing to do, but is completely inadequate in assigning nutrient deficiency, as bioavailability – that is the absorbable fraction of a given nutrient within the context of a given food – is highly dependent on context.^5–6 This means, that someone, who eats a large amount of a nutrient, may still be deficient in that nutrient, should the bioavailability of that nutrient be too low in the dietary context of the given patient. Likewise, someone, who eats a small amount of a nutrient, may still be sufficient in that nutrient should the bioavailability of that nutrient be high enough in the given dietary context.

One of the most common such incorrectly assigned nutrient deficiency is the ostensible deficiency in vitamin C of human subsistence carnivore. This myth has its origins in the incorrect assumption, that meat doesn't contain vitamin C.⁷ Since then, it's become known, that meat does indeed contain vitamin C,⁸ whereupon the myth has begun to change its form, now positing, that subsistence carnivores are still deficient in vitamin C, due to the low amount of vitamin C in meat. This neglects the consideration of bioavailability.

In fact, I haven't been able to find a single report of a human subsistence carnivore being deficient in vitamin C, whether living in indigenous or Westernised populations. On the contrary, it's well known, that the consumption of meat prevents and cures scurvy (severe vitamin C deficiency), when meat is eaten fresh, or when meat is eaten, which was fresh before being tinned.⁹ It's not entirely clear, whether this is solely based on the vitamin C content in meat or due to the high carnitine content in meat, which could lower vitamin C requirements.¹⁰

Thus, it's important to not only consider raw amounts of a nutrient within a given food context, but to also consider bioavailability in said context. A nutrient deficiency should only then be assigned, when the patient has actual physiological drawbacks because of the missing nutrient.

With that out of the way, we can now also intuitively understand why hidden hunger is so dangerous.

The Danger of Hidden Hunger

The characterisation of hidden hunger is specifically, that it can't be detected by the brain. This also means, that people may suffer from mild symptoms of nutrient deficiencies, which go completely undetected, because they understand it to be a normal feature of ageing and no comprehensible blood test is made to investigate serum levels of all essential nutrients.

Most commonly, serum levels of nutrients are only investigated, if a nutrient deficiency is suspected by the medical practitioner.^11–12 Very seldom is it, that serum levels of all nutrients are established in general check ups. The basis for this is probably that classical Western medicine is a system of sick care focusing on the therapy of illnesses and the management of their symptoms and not a system of health care focusing on the prevention of illnesses and management of their causes.

The reason for this is multi-causal, but has to do with financial incentives for pharmaceutical companies, medical insurers, and doctors, as well as patient laziness. Pharmaceutical companies have a vested interest in getting their drugs bought and used. Medical insurers have a vested interest in paying out their fees as late as possible, so that they can have a longer timeframe in which to invest in financial markets. Medical practitioners have a vested interest in getting paid, and stupidly we don't pay our practitioners for getting and keeping us healthy, but only for as long as we're sick. And lastly, we ourselves have a vested interest in spending as little time in a doctor's office as possible. So, we delay until we're heavily encumbered with symptoms no longer manageable, before we visit them. If this topic of system dynamics and systemic incentives in our medical system interests you, just write me an email or comment on this post, and I can write at greater length on this fascinating topic.

For now, let's get back to hidden hunger.

Because our medical system is far more focused on acute sick care, and not preventive healthcare, we seldom test serum nutrient levels, and even if we test for them, we neglect testing for most of these nutrients. The problem with this is that the consequences of nutrient deficiencies are as manifold as they can be severe.

Notable examples include magnesium and iron deficiency. Magnesium deficiency causes inability to suppress sympathetic tone, increases blood pressure, worsens sleep onset and quality, and through all of this increases stress.^13–15 I think you can see how magnesium deficiency could hide in plain sight. It's "normal" for us to acquire hypertension, as we age, it's "normal" to sleep worse, as we age, and it's "normal" for us to be stressed in our adult lives. Iron deficiency is similar. It causes shortness of breath, fatigue, palpitations, and tachycardia, all of which can easily be attributed to "eh, I'm just getting old".^16–17

The truth is, you may not be "getting old" – though you do indeed get older every year –, but simply be suffering from hidden hunger. The association I make with ageing here would naturally open up the question, whether such hidden hunger or nutritional deficiencies are more common in the older over the younger population. I nterestingly hidden hunger does increase due to various factors in the later half of life.¹⁸ However, infants, children, adolescents, and women of reproductive age have higher nutrient requirements and thus experience higher incidence of hidden hunger, with 18.1% of women between the ages of 15–49 experiencing anaemia.

Given the ostensible high quality of the diets in Western countries with all their fortification, this may seem odd. So, let's dive into the causes of hidden hunger.

The Origin of Hidden Hunger

All known biological life adapts to its environments. To do so, it uses stress-responses to adapt rapidly, and genetic drift to adapt much more slowly but more drastically across generations.^19–21 To understand this twofold mechanism of adaptation, we can look at human skin colour. Darkness of skin – or melanin content – is determined both by genetic and environmental factors, like UV-irradiation.^22–24 You can't change your genetics, but the genetics of your descendants can change and be vastly different from your own. In essence, your genes determine the environmental range, within which you as an individual can adapt to survive, thrive, and procreate. They give the limits of your adaptability, but don't predetermine your individual adaption.

What does this have to do with hidden hunger?

Well, deficiencies in nutrients is nothing if not an environmental variable to which your body needs to adapt to survive and procreate. We can see this most drastically, when looking at vitamin C in humans and chickens. In humans, vitamin C needs to be absorbed from food, but chickens can synthesise it themselves.²⁵ Humans can deal with various levels of vitamin C by use of stress-responses to insufficiency or excess, but we can only do so within a certain range, which is genetically determined. We can't deal with toxically high doses, which would simply kill us, neither can we deal with too low doses, which would also simply kill us. Chickens have the genetic determinant, that they can synthesise vitamin C themselves. This drastically broadens the range of dietary vitamin C they can deal with.

Like most animals, it's logical, that humans evolved for a cluster of similar dietary patterns, which determine the range of dietary nutrient sources we can cope with. Our modern dietary pattern is a stark divergence from our ancestral one, relying on refined sugars, starches, and oils unavailable to our ancestors. Whilst there is much debate what exactly our ancestral pattern was, it seems to have been based on meat, fish, and gathered edible plants, whatever their actual respective proportions.^26–30 At no point in our history before the agricultural revolution was our diet based on refined sugars, starches, and oils.

So, is that it? Hidden hunger comes from our change in dietary pattern.

Well, partially, but there are indications, that there's more to it.

Though it's not entirely clear, that this trend is going on all over the world, there seems to be an emerging trend of decreased mineral content in soils and crops in some regions of the world.^31–32 The fortification of grains with trace minerals may also be masking some of the decreasing soil quality.

The problem would be expected to occur primarily with minerals – and less so for vitamins, essential amino acids, and essential fatty acids –, because minerals can't be synthesised by the plants and animals on our agricultural land. The transformation of one mineral into another or generation of minerals from other matter would require nuclear reactions, not biochemical ones. I think, it's obvious, that such reactions don't occur in biological contexts.

And this brings us all the way back to our genetic adaptation I mentioned above.

The primary problem seems to be, that we simply aren't evolved to eat the foods we're eating nowadays, not just by type of food, but also by density of nutrients. Thus, changes in dietary pattern, fortification of food and feed, and/or supplementation become necessary to achieve appropriate nutritional quality of our food and to circumvent the hidden hunger and its negative consequences.

So, what's the significance of this hidden hunger for cancer patients?

The Significance of Hidden Hunger in Cancer Care

One of the main functions of the immune system is the destruction of defective cells, both before and after they become fully cancerous cells.³³ Cancer cells will evolve various ways to evade immune detection and destruction. It's logical, that an unhealthy immune system, functioning far below its capacity, would indeed be less apt at killing cancer cells, than a healthy immune system.

Like most systems of our body, the immune system too – or rather its constituent cells – need nutrients. If we fail to provide such nutrients to the cells of our immune system, they become progressively worse at fulfilling their function. In fact, malnourishment is a good predictor both of the development of cancer in healthy patients and of worse outcomes in cancer patients.^34–36 Vitamin and mineral supply is commonly worse in cancer patients. Particularly critical are nutrients involved in immunomodulation and antioxidation. This would include such vitamins and minerals as: vitamins A, B₆, B₉, B₁₂, C, D, E, Zinc, Iron, Copper, Selenium, and Magnesium.^37–39

Furthermore, peripheral neuropathy is a known adverse effect of chemotherapeutics, expressing itself in patients as cold, tingling, or numb feet and/or hands.⁴⁰ The vitamins B₉, B₁₂, and D₃ seem to be most heavily implicated in such peripheral neuropathy, but it wouldn't be far fetched, that deficiency with other nutrients – though less studied – could have a similar impact.^41–44

The association with chemotherapeutics, would indicate, that such chemotherapeutics damage the peripheral nerves during administration or deplete nutrient pools. It would thus be expected, that the affected neurones recover, given time and sufficient nutrition. If they're not given either, they'd have no way of being able to recover, and the patient will continue to have cold, tingling, or numb feet and/or hands.

Furthermore, the supplementation of acetyl-L-carnitine has robustly improved peripheral neuropathy in mouse models and human patients.^45–46 Evidence for the benefit of coenzyme Q10 and NAD⁺ supplementation has also come forth in preclinical trials, though not yet in human trials.^47–48

I thus think it would be sensible to get a blood image of all nutrients, so that supplementation of deficient nutrients can be made in a targeted manner. Whilst categorical supplementation of essential nutrients at sub-toxic doses is fine, it may be fiscally wasteful, when unnecessary and already covered by diet. Depending upon where in the world you are and how expensive full nutrient blood panels are in comparison with supplements, it may be more responsible to engage a lab for a full nutrient blood panel, or vice versa.

If a nutrient panel isn't feasible, it may be advisable for cancer patients to supplement the above mentioned critical nutrients, especially those not already supplied at high concentration by the dietary pattern used. This of course depends heavily on the specific dietary pattern, wherefore it's difficult to make a more precise recommendation here. Nonetheless, I'll share safe supplementation doses for the above critical nutrients, as involved in peripheral neuropathy.

Maximal Safe Doses of Critical Nutrients

For the vitamin D₃, I'd kindly refer you to our Mosaic Method Guide, where we discuss the supplementation of this vitamin in great detail.⁴⁹

As for vitamin B₉, it should optimally be supplemented in the form of 5-methyl tetrahydrofolate, as it is both more immediately and universally bioactive across patients and simply doesn't exhibit the risk of folic acid accumulation in the blood.⁵⁰ Supplementation of 5-methyl tetrahydrofolate is considered perfectly safe at 1 mg/day in adults.⁵¹

For vitamin B₁₂, there is no established upper limit for daily intake.⁵² Supplementation with up to 50 µg/day doesn't seem to have negative effects in adults.

Closing Remarks

To summarise the three most important findings of this article, I would say the following:

1. It's essential to differentiate between low raw nutrient intake and actual nutrient deficiency as the two are not equivalent.
2. Hidden hunger is highly prevalent in the population, goes almost entirely undetected, and is a epidemiological risk factor for both the development of cancer and mortality from cancer.
3. Importance of nutritional status for cancer patients makes it essential to satisfy hidden hunger by using targeted supplementation, or to use broader preventive supplementation regimens, when targeted supplementation isn't available due to blood imaging constraints.

I hope this has been informative. If you want help with implementing the findings of this article or the more plentiful interventions of our Mosaic Method, don't hesitate to reach out to us at marchward.com/outlive.

Swift healing and lasting health to you.

God bless,
Merlin L. Marquard.