Nutritional Physical Exam

Blood Pressure:

• Orthostatic hypertension


Consider:  adrenal insufficiency, hypothyroidism, anemia
• Hypertension in a pregnant woman (accompanied by ankle edema)


Consider:  deficiency of protein, magnesium, vitamin B6

Hair:

• Extremely painful when hair is gently pulled


Consider:  deficiency of vitamin D
• Flaky dandruff


Consider:  deficiency of selenium, EFAs, vitamin B-complex with emphasis on vitamin B6
• Dull, lifeless hair


Consider:  deficiency of EFAs
• Thinning hair in a postmenopausal woman


Consider:  deficiency of DHEA
• Thinning hair in a woman taking birth control pills, pregnant or postpartum


Consider:  deficiency of vitamin B-complex with emphasis of vitamin B6 and folate
• Thinning hair in a woman not taking birth control/estrogen or pregnant


Consider:  deficiency of hydrochloric acid and pepsin
• Hair loss


Consider:  parasites or heavy metal toxicity
Consider:  deficiency of vitamin B-complex, EFAs
• Premature graying


Consider:  deficiency of PABA

Eyes:

• Cataract in the older patient


Consider:  glucose imbalance
Consider:  deficiency of vitamin B2, vitamin A, vitamin C, zinc, selenium, magnesium
• Floaters


Consider:  deficiency of choline, inositol, methionine
• Retinitis pigmentosa


Consider:  deficiency of calcium, vitamin D
• Dark circles under both eyes


Consider:  allergies, fatigue, emotional upset, pregnancy, hormone treatment
• Dilated pupils to 1/4 inch or more in a child


Consider:  allergies, especially to milk

Nose:

• Polyps


Consider:  allergies, especially to salicylates including aspirin, artificial colors and flavors and white willow (salix alba)
• Loss of smell


Consider:  deficiency of zinc, vitamin A

Ears:

• Hardened or excessive ear wax


Consider:  deficiency of EFAs
• Cracking behind ears


Consider:  deficiency of zinc
• Diagonal crease across lobes


Consider:  cardiovascular disease
Consider:  deficiency of vitamin E
• Fluid behind TM or recurrent otitis media


Consider:  allergies, especially to milk
• Tinnitus


Consider:  allergies, aspirin toxicity or cardiovascular disease

Mouth:

• Cheilosis


Consider:  deficiency of vitamin B2, vitamin B-complex
• Loss of taste


Consider:  deficiency of zinc
• Enlarged tonsils in children


Consider:  food allergies

Teeth:

• Periodontal problems


Consider:  deficiency of co-enzyme Q10, folate, antioxidants, calcium, vitamin C
• Bruxism


Consider:  allergies or stress

Tongue:

• Pale tongue with pale buccal membranes and inner surface of lower eyelids


Consider:  anemia
• Geographic tongue


Consider:  deficiency of folate, vitamin B12, zinc
• Swollen and scalloped


Consider:  food allergies

Face:

• Acne in a teenager


Consider:  allergies
Consider:  deficiency of zinc, EFAs, selenium in boys
• Dilated capillaries on cheeks and edges of nose in men


Consider:  alcoholism
Consider:  deficiency of hydrochloric acid and low pepsin production
• Reddened facial skin, usually on forehead and cheeks with scattered acne-like lumps


Consider:  deficiency of hydrochloric acid and low pepsin production
• Slightly yellow tone to facial skin in an older person


Consider:  deficiency of vitamin B12, folate, vitamin B-complex
• Seborrheic dermatitis on eyebrows, center of forehead, angles of nose, or chest


Consider:  deficiency of PABA, vitamin B6, vitamin B-complex, EFAs

Skin:

• Slightly yellow


Consider:  overconsumption of carrots or hypothyroidism (thyroid provides the hormone necessary to transform beta carotene to vitamin A)
• Dry/rough


Consider:  deficiency of EFAs, vitamin A
• Multiple pigmented skin tags


Consider:  diabetes mellitus, especially if female
• Yellow spots, pimples under eyes


Consider:  diabetes mellitus or hypoglycemia
• Red nodules on elbow


Consider:  deficiency of EFAs
• Dermatographism


Consider:  allergies
• Follicular hyperkeratosis


Consider:  deficiency of vitamin A, EFAs, zinc
• Slow wound healing


Consider:  deficiency of vitamin A, EFAs, vitamin B6, vitamin C, zinc
Consider:  heavy metal toxicity
• Dry, grayish skin


Consider:  deficiency of biotin
• Dry, scaly skin


Consider:  cadmium toxicity
• Scaly dark dermatitis with pigmented lesions


Consider:  deficiency of vitamin B3
• Yellow with pallor and eruptions


Consider:  selenium toxicity
• Irregular brownish/yellowish discoloration on anterior surface of lower leg


Consider:  diabetes mellitus
• Fissures in heels in men


Consider:  deficiency of EFAs, zinc
• Easy bruising


Consider:  deficiency of vitamin C, vitamin K

Hands:

• Dry with fissures on knuckles


Consider:  deficiency of EFAs
• Callouses and contractures


Consider:  deficiency of vitamin E

Nails:

• Flattened and spooned


Consider:  iron deficiency anemia
Consider:  deficiency of hydrochloric acid or malabsorption
• Thin, weak, bend easily in women


Consider:  hypothyroidism
Consider:  deficiency of hydrochloric acid and pepsin, EFAs, calcium, zinc
• White spots on nails, for teenagers


Consider:  malabsorption due to gluten/gliadin intolerance (wheat allergy) or low pancreatic enzymes
Consider:  deficiency of zinc
• Cracks and splits at fingertips


Consider:  deficiency of zinc, EFAs
• Paronychia


Consider:  deficiency of EFAs, zinc
• Brittle/splitting nails


Consider:  deficiency of hydrochloric acid and vitamin B12
• Brittle nails


Consider:  deficiency of calcium, iron, zinc
• Horizontal and vertical ridges


Consider:  deficiency of vitamin B-complex
• Dryness with rounded or curved nail ends


Consider:  deficiency of vitamin B12
• Hangnails


Consider:  deficiency of protein, folate, vitamin C
• Discoloration


Consider:  diabetes mellitus or allergies

Musculoskeletal:

• Bursitis


Consider:  deficiency of vitamin B12

• Costochondritis


Consider:  deficiency of vitamin B6, spinal adjustment

• Degenerative arthritis, especially with crepitis behind the patella


Consider:  deficiency of niacinamide, glucosamine
• Enlarged, painful nodule below the patella on the anterior side


Consider:  deficiency of vitamin E, selenium
• Pain in lower leg if pressure is applied to tibia


Consider:  deficiency of calcium, niacinamide

Copyright 1998 - 2008 by L. Vicky Crouse, ND and James S. Reiley, ND. All rights reserved (ISSN 1527-0661).