from population health to personalized health

Baze White Paper: Transforming Population Health into Personalized Health through Targeted Nutrition

Micronutrient Status Optimization Provides Tremendous Benefit and Should be a Premier Prevention Tool for Personalized, Smart Healthcare in the 21st Century

A Baze Whitepaper

Written by Alex Lewis, RD, LDN, Joshua Kotfila, PhD, Philipp Schulte, Allison Baker, MS, RD, LDN, Eugenia Alfine, PhD(c), and Juliana Dewsnap, RD, LDN, CPT.


Part 1: Micronutrients are Essential for Our Health, Yet We’re Not Getting Enough

Micronutrients are the vitamins and minerals that are essential for our bodies to both survive and thrive. These nutrients form the foundation for a wide array of metabolic processes necessary for survival: growth and development1, energy production2, blood clotting3, immunity4, and cognitive function5 to name a few.

The importance of micronutrients cannot be overstated6. However, even citizens of developed nations are not getting enough of these nutrients according to the dietary reference intakes (DRIs) for healthy individuals, set forth by the Food and Nutrition Board7.

Over 90% of Americans fail to meet the Estimated Average Requirement (EAR) or the Adequate Intake (AI) for at least one vitamin or mineral8–15, with specific populations being especially at risk16.

Percent of US adults who consume less than the Estimated Average Requirement (EAR)10,15

The true reality of insufficient micronutrient intake may be even higher than these estimates for two reasons.

  1. EARs are established for healthy populations only, which leaves out the estimated 60% of American adults managing chronic diseases17.
  2. EAR values are “set at a level assumed to ensure nutritional adequacy”7 for short term impact, like avoiding scurvy and other diseases of nutrient deficiency, not optimal health for long term well-being. This means the healthy population utilized to determine EAR values may just be apparently healthy as explained by The Triage Theory.

According to the Triage Theory posited by biochemist, nutrition scientist, and National Medal of Science winner Bruce Ames, the body has a built-in rationing system for micronutrients, wherein the body prioritizes survival over longevity when nutrient intake is deficient. He states, the “official EAR values might actually have been set too low, because they did not take long-term triage effects into account, and thus more people would be erroneously considered ‘adequate’”18.


Triage Theory19

“The triage theory posits that the spectrum of functions for a particular vitamin or mineral (V/M) are managed by the organism such that, when micronutrient availability is limited, functions required for short-term survival take precedence over functions whose loss can be better tolerated (e.g. by selection for micronutrient binding constants or targeted tissue distribution). Ames proposed that a consequence of this evolutionary adaptation is an increase in the risk of chronic diseases of aging when V/M availability is limited.”

The “triage theory”: micronutrient deficiencies cause insidious damage that accelerates age-associated chronic disease

Insufficient micronutrient consumption is multifactorial

Evolving factors over time contribute to why we aren’t getting enough micronutrients in our everyday life.

  • Consuming processed foods has increased, which takes up a larger percentage of calories in the average diet, leaving less room for nutrient-dense alternatives20.
  • Decreased nutrient density in soil decreases the nutrient value of both conventional and organic foods21.
  • Increased popularity of fad diets promoting calorie restriction and restrictive diets for medical purposes makes it more difficult to meet nutrient demand22.
  • Rising rates of obesity have increased nutrient demand for many larger bodies. This is not taken into account with the DRIs set for healthy populations23.
  • Increased medication, antibiotic use, and environmental toxin exposures have increased the physiological demand for metabolism and detoxification-related nutrients24–26.
  • Psychological stressors are on the rise, which has been found to be a driver of micronutrient depletion27

The contributors mentioned above shed light on why the typical argument of “just eat a balanced diet” does not bode well for the majority of Americans. Especially given that even individuals who meet the EAR for essential nutrients still carry a 16% risk for having at least one nutrient deficiency16.

With these factors working against us on a daily basis, the reason behind why insufficiency numbers are so high in our overfed nation becomes clear. It’s not surprising that the term hidden hunger, a form of malnourishment originally coined to describe populations in developing countries, is now being used to describe specific populations in the US as well.


Hidden Hunger28

“Hidden hunger is commonly used to describe individuals who may have adequate energy consumption, but suboptimal micronutrient intakes, placing them at risk for nutrition-related diseases. When prolonged, inadequate dietary intake of micronutrients (vitamins and minerals) and macronutrients (fat, protein, and carbohydrates) can have adverse effects on health outcomes that may result in a cycle of sub-optimal health…As hidden hunger may often not show physical symptoms, the condition can be easily overlooked by clinicians and is not always well diagnosed or documented.”

From: Hidden Hunger: Solutions for America’s Aging Populations

Suboptimal nutrient status leads to suboptimal health

Poor diet (low intake of fruits, whole grains, nuts and seeds and high intake of sodium for example) accounts for 1 in 5 deaths worldwide, the majority from cardiovascular disease with smaller amounts from cancer and type 2 diabetes29. Perhaps unsurprisingly then, a systematic analysis for the Global Burden of Disease Study 2017 revealed that poor diet is the number one mortality driver; responsible for more deaths than any other risk factor studied29.  The State of US Health, 1990-2016 study similarly showed dietary risks to be the leading risk factor for death in the US30.

In addition to mortality, research consistently demonstrates concrete examples of how micronutrient deficits are associated with negative health outcomes.

  • Poor vitamin D status (blood levels either too low or too high) is associated with an increased risk of headaches31, liver disease32, diabetes33, multiple sclerosis34, cognitive decline35,36, rheumatoid arthritis37, cancer38–46, hypertension47, heart disease48,49, bone fracture50,51, and death from all causes51.
  • Low serum magnesium is linked to an increased risk of coronary heart disease, heart failure, and sudden cardiac death52,53.  Low magnesium intake is associated with an increased risk for type 2 diabetes, colorectal and other cancers, hypertension, osteoporosis, and metabolic syndrome54,55.
  • Low blood levels of omega-3 fatty acids are associated with higher rates of cardiovascular disease, cognitive decline, melanoma and other cancers, and other non-communicable diseases56–58.   
  • Low levels of vitamin A increase susceptibility of various infectious diseases59.
  • Folate deficiency is associated with various cancers60,61.
  • Low levels of vitamin B12 are associated with an increased risk of coronary heart disease62,63, multiple sclerosis64, cognitive decline, and Alzheimer’s disease65.
  • Low vitamin E intake is associated with a higher risk of cataracts66

Adding to these examples, it’s important to keep two additional considerations in mind.

  1. Blood nutrient level deficiency data is scarce at the population level. Historically researchers and government agencies have relied on surveys and intake assessments to extrapolate status as blood testing has come with headaches at scale (expensive, inconvenient, and time-intensive). This means there could be negative health consequences not yet attributed to blood nutrient levels because we simply don’t test nutrient levels frequently enough at population levels to show any sort of significance.
  2. Milder forms of one or many nutrient deficits are harder to recognize and attribute symptoms to until a person has gone through advanced stages of biochemical and physiological consequences. These “subclinical deficiencies” may take years to develop into outward symptoms despite causing damage at the molecular level67.

Part 2: How Do We Fix This? 

We have demonstrated that optimal nutrient status is one important aspect of survival and longevity; a key factor in which a large majority of Americans are not reaping the benefit. Just as the cause of suboptimal nutrient intake and status is multifactorial, so too is the solution. It cannot be overstated—simply eating a balanced diet is not the ultimate solution, but it is one important piece of the puzzle.

Solutions to this expansive issue can be grouped into two areas: building a diet foundation and optimizing nutrient status.

Building the Foundation:

  • Increased diet quality and consumption of nutrient-dense foods68
  • Increased biodiversity of the soil69
  • Nutritional screenings, particularly in at-risk populations70
  • Increased diet education, particularly in at-risk populations71

Optimizing Nutrient Status:

  • Targeted nutrients and dietary supplements
  • Greater testing and awareness of individual nutrient status

While public health policy drives dietary foundations, the remainder of this paper will focus on how innovatively targeting nutrients through testing and personalized solutions can help close the suboptimal gap.

The supplement paradox

Dietary supplements are one inexpensive and effective solution to optimizing nutrient status when utilized appropriately. Americans seem to agree—77% reported taking dietary supplements according to a 2019 report72, but how effective is this strategy?

While blindly supplementing micronutrients has proven to be somewhat effective in decreasing the percentage of the population who do not meet the EAR intake recommendations10, study after study shows these supplements don’t actualize the hypothesized real health impact. Longitudinal studies executed in both healthy and chronic disease populations found little to no benefit from supplementation in the areas of cognitive function, cancer, cardiovascular disease, prostate cancer, ischemic strokes, and all-cause mortality73–80. Additionally, some found some risk for toxicity or harm with excessive supplemental nutrients over time81,82.

Why aren’t they working as expected?

The problem is simple: the process of how we take supplements is broken. Specifically, it does not take into account the individual micronutrient status and deficiencies when deciding on what and how much to supplement.

The underlying logic to this approach is seen on the molecular level. Many micronutrients actually follow a U-shaped association for optimal status relative to disease risk, with low and high levels both resulting in compromised physiological functioning83. Blind, generic supplementation rarely achieves this often-narrow optimal zone for each nutrient.  To understand and then aim for optimal status, status must be accurately measured, not assumed.

Part 3: A Paradigm Shift is Required: Personalized Nutrients Enable People to Feel the Benefits of Optimal Nutrient Status 

The work of Baze Scientific Advisory Board member, Dr. Eran Segal, highlights that each individual has specific needs that can only be understood by measuring what’s going on inside their body84,85.

So, given its central importance: how do we best assess nutrient status? Status has conventionally been measured by intake, ascertained through questionnaires and food diaries.

While measuring intake through recalls is more accessible, the reality remains that:

  • Nutrient density of food, even the same types of food, is variable86,87.
  • Memory-Based Dietary Assessment Methods carry many accuracy and validity issues: failed memory, inaccurate portion estimations, recall bias, etc.88,89.
  • Nutrient absorption varies among individuals for a wide range of reasons (genetics, chronic disease, age, etc.)90,91, which diet recalls don’t account for.

Simply put, measuring intake produces unreliable data and unclear expectations around actual nutrient status. Thus, to understand nutrient status, we should not measure intake but instead focus on actual blood nutrient levels. This is one of the key elements that make personalization scientifically sound.

Blood-based biomarkers offer a clear and dynamic window into nutrient status

Blood testing offers superior accuracy compared to other non-analytical approaches. In many cases, the specific blood nutrient level reflects its true stores in the body. Only with blood testing can you determine where an individual falls on the U-curve for optimal status relative to disease risk.

Additionally, while overt deficiencies provide clear symptoms, allowing for prompt intervention, more often, subclinical deficiencies aren’t spotted right away unless you dig deeper. In the case of vitamin B12, for instance, mild deficiency can cause tiredness92. This is a very generic symptom that isn’t very informative on its own but can easily be explained by a blood test.

With today’s state of the art analytical tools, it’s possible to safely and accurately measure micronutrients at the nanomolar level and to follow these levels over time. By doing so, a dynamic plan arises to allow an individual to take action towards optimal status. It is at this optimal status where the maximum impact is achieved, seen, and felt within the body.

Studies show being in optimal nutrient ranges provide countless positive health impacts 

A growing body of research on the impact that optimal nutrient levels can have on the quality and longevity of life has been conducted over the past few years. One prominent example is Vitamin D, where a Cochrane review of 56 trials with a combined total of 95,286 participants found that simply intake, i.e. untargeted supplementation of Vitamin D was associated with a 2% lower risk of mortality93. In contrast, Zitterman et al. conducted a meta-study on all the research that looked at optimizing Vitamin D blood nutrient status94. The results showed a staggering 31% decrease in all-cause mortality, demonstrating the efficacy of measuring and dosing for nutrient status as well as the U-shape idea of optimization. Similar impact has been demonstrated for other nutrients. For example, supplementing to the optimal range in vitamin A lowers all-cause mortality by 18%95. Omega-3 fatty acids lower all-cause mortality by 42%96. Zinc shows a similar lowering of mortality by 31% when supplementing to the optimal range97.

Part 4: Baze Case Study: We’re Making It as Easy as Possible to Access and Optimize Nutrient Status in Order to Feel the Most Benefit

Baze gives people the opportunity to measure, optimize, and re-measure the blood status of key, health-driving nutrients and to experience the tangible health impacts. It begins with the “Baze Zone.” This is an individual’s optimal blood level for each essential nutrient—the level at which research has shown real benefits like improved immunity, energy, and longevity. We establish and update Baze Zones for key nutrients as the research evolves. These targets are unique to Baze and form the basis of our entire solution: evidence-driven results.

The process: accessible and actionable

The outcome: personalized and preventative healthcare for all

For the first time ever, we are giving customers the opportunity to truly optimize their nutrient status—because the data is clear on the importance of doing so. And our 2019 internal impact data is impressive. 73% of nutrient deficiencies were resolved after the first 3 months of personalized supplementation. It’s measurable, molecular change that can’t be argued. 

Only Baze provides the unique targets, gets smarter and more accurate with re-testing, and can really show how the actions customers take overtime actually change their biometrics. This 360-degree approach is revolutionary while also being really simple, and it’s never been accessible in the way it is today.

We’re excited to continue to grow and expand both the data inputs (additional biomarkers and health and lifestyle data that helps better adjust the individual nutrient dosage) and the recommendation outputs (adding in food, beverage, and lifestyle options to help close nutrient gaps).

We are building the world’s most powerful personalized nutrition platform, based on cutting edge science, and we hope to bring this solution to as many people as possible as we transform population health into personalized health. 


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