Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
26 Apr

2 More Common Nutrient Deficiencies (and What to Do About Them)

In our rush to ditch processed, boxed, packaged, refined foods, we run the risk of missing out on several key nutrients that they come fortified with, courtesy of food producers (what would we do without them?!) who recognize that the people who live off their nutrient-free food products need some actual nutrition amidst the sugar and the crunch. In case you don’t know what I mean, swing through the cereal aisle of a grocery store sometime and check out the nutrition facts for a few products. A single serving of something like Frosted Flakes is fortified with most of the B-vitamins, vitamin D, vitamin C, vitamin A, iron, and folic acid, often the full RDI. Well, it turns out these nutrients are attainable through actual food. No, really. So instead of relying on Frosted Flakes for our iron, or Wheaties for our zinc we can eat real food. But sometimes the real foods that contain the nutrients we need aren’t the ones we think to eat, and this can become a problem.

That said, let’s look at a couple more nutrients (I covered five last week) that I suspect people may be missing out on.


Manganese. How many of you have scanned this word and assumed it was magnesium, perhaps misspelled? I know I have, but I also know that it’s one of those trace minerals that regulates dozens of enzymatic reactions in the body, and that it’s really important. It’s also a primary constituent of one of our favorite endogenous antioxidants, manganese superoxide dismutase, which is active in our mitochondria.

Deficiency Symptoms

  1. Asthma – Low manganese levels are consistently associated with childhood asthma, while one study found a similar relationship between dietary manganese intake and asthma in adults.
  2. Ineffective utilization of several key nutrients – Choline (see below), thiamin, ascorbic acid, and biotin all require adequate manganese to be utilized by the body.
  3. Low thyroxine (thyroid hormone T4) – Manganese is essential in the production of T4.
  4. Osteoporosis and joint pain Bone mineral density doesn’t just come down to calcium (or magnesium). Manganese also plays a small but important role in skeletal health. Consider the story of Bill Walton, basketball legend and the greatest hyperbolist in the history of Western Civilization, who was diagnosed with osteoporosis at the height of his career after a series of broken bones that would not heal. The cause? A macrobiotic diet that left his serum manganese levels entirely undetectable.
  5. Low HDL – In women fed a manganese-deficient diet, HDL plummeted (PDF).

Why Might Deficiency Occur?

  1. Insufficient intake of manganese-rich foods. This is an obvious one. If you don’t eat manganese, you’re not going to have enough of it. If you’re only eating beef, shy away from berries, hate shellfish, and avoid all nuts all the time because of omega-6, you may be missing some manganese.
  2. Iron overload. This isn’t a true “cause” of deficiency, but for those with hemachromatosis, or excessive iron absorption and retention, manganese can reduce the absorption of dietary iron. Primal eaters – who are almost invariably eating iron-rich meat on a regular basis – may be getting less manganese than they need, especially if they’re avoiding most of the richest sources of the mineral.

Where to Get It

  1. Nuts. In descending order from richest, hazelnuts, pine nuts, pecans, walnuts, mac nuts, and almonds are all good sources of manganese.
  2. Bivalves. Mussels are the best source, followed by oysters and clams.


Shoot for 2-5 mg per day or so.


Choline is the precursor for acetylcholine, a neurotransmitter involved with memory; it’s an integral component of two important phospholipids; and the liver uses it to process fats and package lipids. The real authority on choline is Chris Masterjohn of the Daily Lipid blog. In fact, I’ll refer to his series of choline posts from time to time, because they do a far better job of explaining than abstracts from PubMed.

Deficiency Symptoms

  1. Fatty liver – The research is pretty clear that a choline deficiency is majorly responsible for fatty liver.
  2. Lowered VLDL – Without choline, very low-density lipoprotein synthesis in the liver is disrupted. While reducing VLDL might make your lipid panel happy, it also sets you up for developing fatty liver, since the fat isn’t being packaged into lipoproteins for dispersal.
  3. Elevated ALT levels – Elevated alamine transaminase levels could indicate liver problems, which are often caused by a choline deficiency.
  4. Elevated homocysteine – A choline deficiency results in a reduced capacity to methylate homocysteine (PDF).
  5. Impaired memory – Since choline is the precursor for acetylcholine, a choline deficiency often manifests as a memory impairment. One study even found that choline supplementation improved memory in humans who were deficient.

Why Might Deficiency Occur?

  1. You’re still scared of dietary fat and cholesterol. The best sources of choline come packaged with fat and cholesterol. I imagine this fear explains the “silent epidemic” of fatty liver across America that Chris Masterjohn discusses, but don’t let it get to you.
  2. You’re still scared of offal. Yeah, yeah, it’s icky, it has a very distinct taste, your grandma used to overcook liver and force you to eat it, whatever. Liver and other offal bits are awesome and essential.
  3. You’re not scared of dietary fat and cholesterol. Huh? Doesn’t this contradict number one? Not exactly. Most of you are all about the fat, and that’s awesome, but eating more fat increases the need for choline. This doesn’t mean you have to reduce the fat; you simply have to increase your choline intake (luckily, Primal fat sources are also often choline sources, as you’ll see below).

Where to Get It

  1. Liver and egg yolks, and probably other sources of offal (brain, kidney, etc).
  2. If you aren’t eating liver and/or egg yolks, you’re going to be deficient in choline. Other sources, except for maybe beef cube steak, pale in comparison.
  3. Supplement. Cell membranes (as in eggs) contain phosphatidylcholine, so look for that version if you intend on supplementing (but getting it through food is so much more fun).


550 mg for men and 425 mg for women, bare minimum. Pregnant, soon-to-be-pregnant, and breastfeeding women should increase their intake considerably, as low choline intake is associated with neural tube defects. Ah, heck, I bet everyone could do with a little more choline in their diets, especially if you’re not scared of dietary fat.

Let me reiterate something about all these nutrient deficiencies: I’m not talking about acute deficiencies, for the most part. You’re not going to end up in the ER with a deathly case of hypokalemia (potassium deficiency). You probably won’t get scurvy from a lack of vitamin C, even while crossing the Atlantic on a crusty galleon, nor will you develop goiter because you’re living on foods grown in completely iodine-deficient soils. And yet milder, somehow more pernicious deficiencies of these nutrients are a real possibility, even among Primal eaters. These are the symptoms that “everyone has,” that are “just part of getting old.” Bad lipids, fatty liver, fibromyalgia, constipation, general fatigue throughout the day – these are the new normal. But because you’re clued in to the state of your body, and you’re not just going through the motions and accepting the “fact” that you’re going to feel like crap most of the time and it’s all out of your control, you notice when things are off. When you notice something’s off, you explore the literature for clues and nutrient interactions and potential deficiencies. And you’ll often find them.

You’re not alone. Plenty of people on the Standard American Diet are deficient in many or all of these nutrients; they just don’t know it, and they never know to test for it. If they’re lucky, they find out they have fatty liver, but their doctor never mentions choline. Their kids might have asthma, but they hear nary a peep about manganese. They’re put on thyroid medication immediately, without exploring iodine and selenium supplementation. They’re developing osteoporosis, and the only nutritional intervention the doctor considers is calcium, before turning to the drugs. There’s no mention of other trace minerals.

Though it may force you out of your comfort zone, the heightened awareness of nutrients and their roles in health and disease is ultimately a good thing. Embrace it.

Well, that about wraps it up. If I’ve made an egregious omissions from this short series of posts, be sure to let me know in the comment section. Thanks for reading!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Your comment about the dark chocolate and raspberries TOGETHER (which I’m very happy to hear, by the way!) made me think of another question I’ve had for awhile that I’d love if you addressed — assuming a healthy individual, what are some beneficial combinations of foods to optimize the benefits they provide? Or what combinations to avoid? I’ve heard something like strawberries and spinach together to help optimize the absorption of Vit C (I think that’s what it was)? Or that eating things with Vit C along with something rich in iron is helpful because the Vit C helps the body absorb the iron? I’m just curious as to good food pairings for general health purposes….

    Thanks! Love your site!

    Ann wrote on April 26th, 2012
    • I am confused about whether chocolate and raspberries have to be eaten together to get full benefit of the manganese.

      Also, I have never gotten clear on the value of liver tablets. I have honestly tried to eat liver and it just isn’t happening.

      Harry Mossman wrote on April 26th, 2012
      • Yes Mark – please reply. I retch at the smell of beef liver, so I’ve been taking desiccated tablets – Argentinian grass-fed beef liver. Of course it is not as good as eating the whole food, but is it adequate for the nutrients? Liver-haters want to know!

        Hillside Gina wrote on April 26th, 2012
        • I’ve been able to start consuming liver by mixing pureed chicken liver with ground beef. 4 pounds of ground beef to 1 pound of pureed chicken liver, throw in any spices you like, make meatloaf or hamburgers or baked meatballs, it doesn’t taste liver-y.

          I have given up trying to consume beef liver.

          Tanya wrote on April 26th, 2012
        • Try pork, calf or lamb livers, chicken livers too. They all have a different flavour and all are great sources of trace minerals and iron.
          I find soaking a beef liver in milk overnight helps draw some of the “funk” out of the meat, and my cats love the treat of the leftover milk added to their usual raw meat and bone diet.

          Jasmine wrote on April 27th, 2012
        • Also, I last found beef liver at the Korean market. Now I can’t find any kind of liver at any store in my town, and I live in a major metro area. No liver to be found! I’m going to have to drive farther and find a good deli that sells chopped chicken liver pate.

          HillsideGina wrote on April 27th, 2012
      • You can find desiccated grass-fed liver *capsules* (the gelatin capsules with the powdered liver inside) through Swanson’s. I’ve bought it before–need to start taking it again, actually. It’s just about tasteless and the smell is pretty mild. I prefer powder capsules over pressed tablets because usually they’re digested better.

        Dana wrote on April 26th, 2012
        • I keep chicken liver frozen. I cut off bits and then cut those into pill size pieces and swallow them whole. The tiniest of mineral-ly aftertaste. I even got my mom to start eating it this way. I think I learned this from Weston Price. I’ve found it the easiest way to eat liver.

          Jamie wrote on April 27th, 2012
      • Have you considered shredding liver into ground beef? I can’t eat liver by itself. But shredded into my burgers I cannot even tell it’s there. I have to be more careful with the beef liver as opposed to the chicken liver, because it has a stronger taste. I don’t ever put too much into my food. :)

        Ute wrote on April 27th, 2012
        • I tried that, it was pretty terrible. I thought I could hide it from myself but it didn’t work :(

          sharee wrote on May 7th, 2012
      • I don’t much like liver by itself but I find it decent cooked in butter and onions with some seasoning, with gravy, mixed with other foods, or with salsa, which will cover up or enhance the taste of just about anything. Just recently I ate 500g of cheese with some peanuts, a can of sardines, and a whole jar (350ml or so) of salsa, and I was nom-nomming like Pacman, it was nice.

        Animanarchy wrote on April 27th, 2012
    • also, when I was preggers I was paranoid about consuming Vit C foods and Calcium foods together because I had read they each hinder the absorption of the other. This baffled me in regards to dark leafy greens, which are supposed to be a good source for both (besides being my favorite food). I’ve since stopped worrying about it, but am quite interested in food combinations for optimal benefit.

      yoolieboolie wrote on April 26th, 2012
  2. Mark!

    I am SHOCKED you did not mention COCONUT as a rich source in manganese. Just 1 oz which is about 100 calories has 21% of the DV!

    I know when most of us drink coconut milk we are consuming 1/2 a cup or more. A 1/2 cup of coconut milk has about 40% of the DV of manganese.

    Cinnamon and other spices are also rich in manganese.

    Primal Toad wrote on April 26th, 2012
    • Does that include pure coconut oil or just products that contain coconut meat, like milk or manna?

      cTo wrote on April 26th, 2012
      • According to, coconut oil has no vitamins or minerals… I think its just products that contain meat like milk or manna. Or butter, cream, shredded coconut, coconut flakes, coconut flour, etc….

        Primal Toad wrote on April 26th, 2012
        • Cool beans! Thanks!

          cTo wrote on April 26th, 2012
    • And the asthma study Mark linked to mentions Tea as a source of manganese and even as the main reason for the differences found in intake between the asthma patients and the controls. But then it was an English study.

      Victor Venema wrote on April 26th, 2012
    • i was wondering about that, too. plus they are so fun to crack open with a hatchet!

      DThalman wrote on April 26th, 2012
    • Actually he did mention nuts:

      “Insufficient intake of manganese-rich foods. This is an obvious one. If you don’t eat manganese, you’re not going to have enough of it. If you’re only eating beef, shy away from berries, hate shellfish, and avoid all nuts all the time because of omega-6, you may be missing some manganese.” – Mark Sisson

      Gretchen wrote on April 28th, 2012
  3. The best way I have incorporated offal into my diet is in chili. I can get fresh, pastured fowl offal readily. A chili is a stew, so first sear the heart, kidneys, and liver. (My offal comes with the necks too, save those to make stock). I also brown 2 lbs of ground beef or bison in bacon fat or lard.

    In a separate pot I have simmered diced aromatics (onion, carrots, celery) and garlic in olive oil. I add my cut tomatos, pablano peppers, maybe a habanero, a can of smoked chipotle peppers, and my spices: tumeric, hot hungarian paprika, coriander, thyme, curry, cinnamon, cocoa and a few others secrets all to taste. Bring to a light simmer.

    Then I add my meats and let the magic of stewing happen.

    I call it “Awfully Delicious Chili”. (Get it?). People love it and do comment on chewing on something that is different.

    liberty1776 wrote on April 26th, 2012
    • what a great place to add offal!

      yoolieboolie wrote on April 26th, 2012
    • Thanks for sharing this recipe. I am still trying to incorporate more offal into our diets. I still find it best to disguise it for the kids (ok and for myself too) 😉

      Happycyclegirl wrote on April 26th, 2012
    • that sound great….!

      rik wrote on April 26th, 2012
  4. I could definitely handle eating more raspberries and dark chocolate to get some more choline! Primal life is good.

    Abby J. wrote on April 26th, 2012
    • Oops, I meant manganese!

      Abby J. wrote on April 26th, 2012
    • No kidding! 😀

      The Primalist wrote on April 26th, 2012
  5. Mark,

    You just defined what Paleo means to me when you stated “you’re not just going through the motions and accepting the “fact” that you’re going to feel like crap most of the time”. Sometimes I get grief from my family and peers about trying to understand every nuiance of how I feel and how I can solve the last little issues. The motiviation that follows feeling healthier is like an addiction in perfection but it’s only because I don’t just want to live, but I want to thrive! Thanks for all you do!

    Tom wrote on April 26th, 2012
  6. Why do dark chocolate and raspberries need to be eaten TOGETHER to get manganese from them?

    PhilmontScott wrote on April 26th, 2012
    • Because they are DIVINE together!

      Angel wrote on April 26th, 2012
    • I had the same question. I’d rather have raspberries at one time and dark chocolate at another. I’d be curious if there is actually a synergistic relationship here.

      Brenda wrote on April 26th, 2012
      • blend dark choc/ raspberries together with plain/ unsweetened organic yogurt for a nice treat. Or mixed with almond butter or coconut mana.

        Jeffrey wrote on April 27th, 2012
  7. egg yolks for the win!

    Becca wrote on April 26th, 2012
  8. I took Mark’s advice and tried liverwurst and it’s not bad! I just cut a few slices for my salad. You can almost pretend it’s hummus and spread it on vegetables or boiled eggs. I also tried smoked oysters, which really don’t cost much more than a can of tuna and they’re wonderful! I add those to salad with sundried tomatoes and olives – yum!

    BootstrapsOnMyFivefingers wrote on April 26th, 2012
    • Saute cabbage and then add sliced liverwurst to the pan. Yum!

      liberty1776 wrote on April 26th, 2012
    • Read the ingredients carefully – hard to find liverwurst that doesn’t contain corn syrup or sugar.

      Hillside Gina wrote on April 26th, 2012
    • smoked sardines are fabulous too!

      mars wrote on April 26th, 2012
  9. I LOVE dark chocolate – and with raspberries is even better! Maybe start your day with a bowl of fresh raspberries drizzled with melted dark chocolate….heaven!

    Carol wrote on April 26th, 2012
  10. Regarding choline. If it is in the shell membrane, I read somewhere that you can add egg shells to your broth, would that make the choline available?

    Belforte wrote on April 26th, 2012
    • It’s not. It’s in the egg yolk. The very part that a lot of people avoid eating, as it happens.

      Dana wrote on April 26th, 2012
  11. Awesome – Mark: I think it time you now concentrate on gut and stool health. It really is about good bacteria and proper stool formation.

    mark wrote on April 26th, 2012
    • I second this. It isn’t extremely pleasant to think about, but nothing makes you feel as “blah” as problems in this department.

      Martha wrote on April 26th, 2012
  12. Well ,for some reason I developed magnesium deficiency a month ago (too much stress at the time I guess). Started to take supplements and all symptoms went away. One never stops learning.

    einstein wrote on April 26th, 2012
  13. Does anyone know off hand which has more choline? Egg yolks cooked or raw? I eat both…just wondering since I tend to eat more yolks cooked or soft boiled.
    Just checked the label on my multi…no choline.

    NicoleK wrote on April 26th, 2012
    • In his December 4, 2010 Daily Lipid, Chris Masterjohn wrote “I haven’t found any evidence that heating foods affects the bioavailability of choline.”

      Harry Mossman wrote on April 26th, 2012
      • Sweet, thanks!

        NicoleK wrote on April 26th, 2012
    • Multis are about as useless for choline as they are for vitamin B12 (you need methylcobalamin for that one, not cyanocobalamin). A guy needs at least 550mg of choline daily and you get a little smidgen of it in most multis. (Probably all, but I’m hedging my bets–don’t want to slander some supplement company unnecessarily.)

      Dana wrote on April 26th, 2012
  14. Hmm well yeah!
    I dont eat allot of shell fish and well I dont really eat allot of nuts or raspberries or dark chocolate..

    guess Ill have to get some of those.
    id guess nuts. there are no raspberries here, and I hate shellfish.

    :) Thanks!

    Sergio wrote on April 26th, 2012
  15. You hint, but don’t state, that pregnant women should eat liver, in contradiction of official advice that liver should be avoided for fear of vitamin A overdose.

    I’ve looked at the numbers. It looks like vitamin A is dangerous to the fetus in doses of more than 10,000 units a day, according to this study. A single massive dose appears to be more likely to cause harm, and supplements were more of a problem than natural intake.

    100g of liver contains about 20,000 units. My suspicion therefore is that a small amount (say 20–30g) of liver now and again during pregnancy should be OK, and would help to prevent vitamin A deficiency, which might also be teratogenic.

    I am not a doctor, consult a medical professional etc. etc. But what do you all think?

    Orielwen wrote on April 26th, 2012
    • I skimmed the results and it seems to me that the supplements is what caused the birth defects, not the food sources. But since the researchers were combining all sources of vitamin A to get an accurate count they didn’t differentiate between the two.

      Krista wrote on April 26th, 2012
      • When I was pregnant, I read that food sources of vit A weren’t a problem. The problem was that when it’s in supplemental form there’s more bioavailability. Like, A LOT more. So it’s easier to get too much. IIRC.

        Kim wrote on April 26th, 2012
        • I would still tell a pregnant woman who can’t stand liver that she should take fish liver oil or some other natural vitamin A supplement. But take it along with vitamins D and K2 (mk-4) to balance it out. I don’t know if the proportions with vitamin K2 matter, but vitamin A to vitamin D should be at least a 10:1 ratio or better (9:1, 8:1, etc. of A to D). They work together and mutually protect against toxicity.

          Dana wrote on April 26th, 2012
        • Vitamin A is retinol. Vegetable food sources of vitamin A contain beta-carotene, a precursor. You need two molecules of beta-carotene to make one molecule of retinol. And beta-carotene is absorbed from the gut at a sixth of the efficiency of retinol. So you need twelve times the amount of beta-carotene to have the same effect as a given dose of retinol. Beta-carotene is also water-soluble and therefore more excretable. Given this, it’s nigh impossible to overdose on vitamin A from vegetables.

          Animal sources of vitamin A contain retinol itself: easily absorbed and more potent, as well as being fat-soluble and thus stored rather than being peed out in excess. So it is possible to overdose on vitamin A by eating liver, the most concentrated source. You are almost certain to overdose if you eat the liver of a carnivore that eats other creatures that are themselves rich in vitamin A. That’s why you should never eat polar bear liver.

          I think the problem with supplements is that if you’re taking a pill every day it’s very easy to get into chronic overdose without noticing, especially if you’re taking several different multivitamins containing retinol, as the effects stack (as well as stacking with any vitamin A you do happen to eat in food). Certainly in the paper I refer to above, the only people taking more than 15,000 units a day were on supplements.

          Orielwen wrote on April 27th, 2012
    • Vitamin A deficiency *is* teratogenic. My daughter was born with vesicoureteral reflux into both kidneys because I didn’t get enough vitamin A in my pregnancy. Her vision’s OK, but kidneys develop much later in the pregnancy than eyes do. I know it’s the vitamin A because I suffered from menorrhagia (heavy bleeding) after my menses came back postpartum, and vitamin A was the only thing that cleared it up. The urologist who treated my daughter told me her problem was hereditary. But the Mayo Clinic says urinary tract defects are the most common defects in the United States. And vitamin A is important in the signaling process that develops the ureteral bud in the fetus–this affects both how the ureters insert into the bladder, and also how big the kidneys get and how well they filter. My daughter’s right kidney is noticeably smaller than her left, and the right ureter was more deformed and refluxed more often. It was the one we had to surgically correct.

      The Weston A. Price Foundation says it is *synthetic* retinols such as Retin-A that cause birth defects, not the natural retinol from liver. It’s also worth noting that liver is a fertility food in most, if not all traditional cultures–they *expect* pregnant women to eat it!

      I warn people about this all the time now. Vesicoureteral reflux is a risk factor for end-stage renal disease later in life–and that condition is so common that Medicare covers it in people under 65.

      Dana wrote on April 26th, 2012
      • That’s really useful to know, Dana, thanks! (Bummer for you and your daughter though.)

        Have you found anywhere that gives an idea of what the ‘ideal’ range of vitamin A intake ought to be during pregnancy?

        Orielwen wrote on April 27th, 2012
      • Dana, you really ought to have your own blog. I learn as much from you as I do from Mark when you both write on the same topic.

        jake3_14 wrote on April 27th, 2012
      • Not specifically about pregnancy, but I researched vitamin A a while back. Certain “facts” are on scores of websites, but I couldn’t find them in the scientific literature. What I COULD find is summarized here:

        If I were to get pregnant (unlikely since I’m past menopause), I would eat liver as you can’t count on carotenes to provide vitamin A.

        jpatti wrote on October 5th, 2012
  16. Great article – really useful thanks.

    We have multiple soil mineral deficiencies here in NZ, manganese is just one.

    julianne wrote on April 26th, 2012
  17. I assume I have some vitamin and mineral deficiencies. One of the first things I plan to buy after getting my welfare money for May is a bottle of multivitamins (and lots of delicious sardines).
    I just hope I can find a multivitamin/mineral supplement that isn’t loaded with industrial fillers, which seems impossible to find based on the last time I browsed a vitamin aisle. Anyone know of a common good brand?
    I’d happily buy the Master Formula but just can’t afford it right now. I used to take Centrum back when I didn’t put much thought into the ingredients of anything but am suspicious of it now.

    Animanarchy wrote on April 26th, 2012
    • We use several Thorne brand supps, available lots of places online.

      Tanya wrote on April 26th, 2012
    • It’s possible to get a separate multimineral where the minerals are chelated. I don’t want to go advertising supplements on Mark’s blog too extensively, as I’m a guest. But you’ll find that multivitamin-multimineral formulas are usually short on the minerals, especially calcium. Though I have heard from multiple sources that most Americans get too much calcium *at the expense* of other minerals, and it’s just as bad to have them way out of balance as it is to not get enough of one or more of them. Especially if you are not taking them in chelated form–then they fight over the ion channels to get into your body.

      Dana wrote on April 26th, 2012
  18. on choline– it’s my graduate student “recreational supplement of choice.” I definitely see a noticable difference in my ability to focus and “get s&*( done” when I take a choline supplement versus not. now i’m thinking I better be more careful to just get in more choline daily! what if I could ALWAYS be on my academic A game.

    Fox Peterson wrote on April 26th, 2012
  19. Mark,

    I love the post. Also, this is my first visit and I bookmarked you. It’s rare to find someone who has the same philosophy on eating/living.

    Anyway, I’m at

    Be well,

    Dr. Kevin

    Dr. Kevin wrote on April 26th, 2012
  20. U.s. Wellness meats has a VERY unique liverwurst (grass-fed beef, liver, kidney, and heart). I know of no other product like this! I just purchased half a grass fed cow from a local farmer, but get the liverwurst from U.s. wellness meats.

    deb b wrote on April 26th, 2012
    • Sounds wonderful, I LOVE liverwurst!

      Brenda wrote on April 26th, 2012
  21. If you think you are missing some micronutrients (Manganese is one of them) I would suggest you to try microalgae… My job is studying them, so I can assure you that, the nutrient composition is almost perfect. For example, from a fast DuckDuckGo search, according to this page ( 100 g of Chlorella have 8 times more Mn than do boiled mussels (5.7 mg against 0.7 mg). And it hase lots of other interesting things.
    Chlorella is quite cheap so I use it as a supplement on a regular basis.

    voingiappone wrote on April 26th, 2012
  22. I freeze chicken livers and then grate them with a microplane into things like stew or chili – not necessarily a lot at one time, but you’d never know it’s there. In fact, my husband doesn’t even know I do it. :)

    Kat wrote on April 26th, 2012
  23. When I lived in Scotland, I fell in love with pate’. When I returned to the USA, I found liverwurst to be a reasonable substitute. I also found several recipes for it in most continental cookbooks. It is interesting to note that I lost about 30 lbs in the 2 years I lived there. Uncured Belfast ham, fresh Bacon, and daily shopping combined with walking miles a day in fresh sea air probably helped, too.
    I take iodine/potassium, selenium, and raw thyroid supplements that have made a big difference in my general health.

    TruckerLady wrote on April 26th, 2012
    • I discovered the same thing – although not because I lived in Scotland, I just discovered pate in an Irish-style pub here in the U.S. I used to make my own at home, using liverwurst spread on a piece of bread, butter, an onion slice, and a bit of pickle. Now I just skip the bread and use a bit of raw cabbage; it’s still delicious.

      Gingerzingi wrote on April 27th, 2012
  24. “You’re not going to end up in the ER with a deathly case of hypokalemia (potassium deficiency).”

    Actually, that is exactly what happened to my step-mom. She is a teacher, and one day she just passed out in class. She had all the symptoms of a heart attack. They rushed her into the ER, and it turns out, that is exactly what it was. Dehydration, plus lack of electrolytes, and your heart can’t work right. They put her on a saline drip, and then sent her home with an order
    to eat bananas.

    “You probably won’t get scurvy from a lack of
    vitamin C”

    And I had a good friend in college, who subsisted on nothing but burgers and ramen noodles, and that is exactly what happened to him!

    Eating in Orlando wrote on April 26th, 2012
    • One sure route to scurvy is to eat too much sugar (or starch) and not enough vitamin C. In animals that make their own vitamin C (which is most of them), they make it from glucose, so C and glucose share the same receptors. So if you’re constantly jacked up on glucose, there’s no room for vitamin C to get in.

      I think the reason we don’t see more scurvy now, though, is that most C supplements and other supplements that include C have it in such huge megadoses.

      Dana wrote on April 26th, 2012
      • interesting that it’s often advised that fruit be eaten separately from other foods for nutritional reasons, and also on my FODMAP diet (for IBS) it’s advised that fruit be eaten separately, for improved digestion. and i do find i can tolerate fruit better if it’s separated from other foods by an hour or two.i’m very fructose intolerant. it seems that my body sends me unusually clear signals about what works for it…and what works for my body seems to line up with the science of nutrition EVERY TIME.

        DThalman wrote on April 26th, 2012
  25. I would try “the other bits of the cow” but we only have one butcher in town and it doesnt look very reputable…even if someone handed me a beef liver i wouldnt know how to prepare it.

    Scilla wrote on April 27th, 2012
    • Slice it thinly and flash fry it. Don’t cook it for too long or it goes rubbery. Goes well with bacon.

      Orielwen wrote on April 27th, 2012
  26. Excellent informative posts Mark. Thanks. I reckon i’m all right for the nutrients covered, except for vitamin K2 as I do have tartar build up on my teeth. Somewhat less than on my conventional wheat and potato based diet of the past, but never the less, an indication that something in my body is not well balanced. I guess I’ll have to get hold of organic, truely pastured (organic can very well mean: fed with organically grown corn and soy and the likes from the husbandry fodder industry) eggs and meat to address the deficiency.

    Gosewin wrote on April 27th, 2012
  27. I have been using a recipe I found here that I get my local butcher to make up. It is 70% beef, 20% beef heart, and 10% beef liver all minced together. The OP said that no-one would notice and they were right. I am on my 3rd 5kg batch and everyone in the family is finding my usual mince dishes more delicious than ever! They have no idea they are getting the heart and liver, but I am thrilled that we all are! So a big thank you to the person that posted that :)

    chocorama wrote on April 27th, 2012
  28. As a potter I’ve been strongly warned of the dangers of too much manganese – supposedly implicated in the development of Parkinson like symptoms. A problem to avoid as it seems to be included in so many vitamin supplements

    Pam wrote on April 27th, 2012
  29. Liver. We’ve got 18 or so kgs of it in the freezer from the last three heifers we killed. Slowly turning itself into gorgeous pate… a bit of onion, garlic rosemary, thyme, red wine and a stack of NZ Grass Fed Butter (it all grass fed here). The Magimix isn’t very primal, but it makes a great pate. Even the dog likes it, although he’d rather it be raw liver.

    kem wrote on April 27th, 2012
  30. Ken, tell me more about this wonderful,sounding pate… I have 200 lbs of grass fed beef arriving soon from the farmer and am interested in exactly how you make your pate.

    I have never made pâté .


    RenegadeRN wrote on April 27th, 2012
    • My husband used to make pate using belly pork and pork liver. Wonderful stuff, but the strips of fat in the belly pork wrap themselves around the blade of the blender and destroy it if you’re not careful. We’ve been meaning to get a new motor unit for years so we can try again.

      Orielwen wrote on April 28th, 2012
  31. Sorry! I typed Kem, but autocorrect attacked it.

    Darn autocorrect!

    RenegadeRN wrote on April 27th, 2012
  32. I believe Mark has blogged about copper deficiency before, but just to reiterate for those who do not eat beef liver – chicken liver doesn’t have enough copper in it. If you don’t eat beef liver you should supplement copper as it’s an essential nutrient & most people don’t get enough. (Hat tip to Paul Jaminet of PHD.) You might be able to improve the taste by soaking it in milk before cooking. I like the idea of hiding liver in meatloaf or chili, I’ll have to try that. It might also work in other strongly flavored dishes, such as curry.

    Leila wrote on April 27th, 2012
  33. What about this mad cow disease outbreak?

    15 years for symptoms, and spontaneous (not from feed?)

    Lance Strish wrote on April 27th, 2012
  34. tldnr all comments, ill just leave this here for the interested

    Wheat bran 2. 6.7 1c 334%
    Unsweetened baking chocolate 1.2 /sq 60%
    Cocoa powder 3.3/c 165%
    Chili powder .07/tsp 3%
    cinnamon, parsley, turmeric, coriander, marjoram .05 1tsp 3%

    raw beef liver 333.1/100g
    Chicken Liver 25.8P 6.43F 326.8/100g
    soy lecithin 300/100g
    Whitefish Eggs (Alaska Na 247.5/100g
    Salmon Red (Sockeye) Filets Wi 223.8/100g
    Cereals Ready-To-Eat Wheat Ger 200.8/113g
    Quart of milk, 1% fat 173
    Half a pound of chicken 150
    egg whole raw fresh 125.55/50g
    beef cube steak(Beef Top Sirloin Separab123.7
    Veal Leg (Top Round) Separable 123.2/100g
    Soybeans dry 116/100g
    egg yolks 2.7P 4.51F #1 avoid Chol115.99/17g
    Large hardboiled egg 113
    cod fish 83.7/100g
    Caviar Black And Red Gran 75.84/16g

    Pedantry wrote on April 28th, 2012
  35. This is a great article! Of everyone I know who raves about the importance of ditching processed foods and giving up carbs, I know exactly ZERO who have ever even thought about losing out on nutrients that their breads, cereals, etc are fortified with. The only time you here someone say “make sure you supplement” is in reference to vegetarianism. We meat eaters need to listen to our own advice!

    Kim Gray wrote on April 30th, 2012

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