In this age of scientific breakthroughs and advanced technology, it's easy to overlook the simple, daily problems that our patients ask us to solve. In this column and the next, I am going to delineate some basic diet-related symptom-patterns.

All nutritional references and studies recommend eating at least six servings of fresh fruits and vegetables each day to maintain health. What do fresh fruits and vegetables contain that canned fruits and vegetables do not? The answer, of course, is enzymes. Besides performing all the biochemical reactions in the body:

*** Indigenous food enzymes can initiate the digestive process if they are present.

*** Enzymes are the key ingredient in your immune system. They are necessary to protect the body from foreign invasion, and they are needed to repair injured tissue.

With all of the over-the-counter drugs available to remove bothersome symptoms, it's easy to forget that inflammation is not a disease but a normal and necessary defensive function.

Therefore, the cardinal signs presented by a body that needs supplemental enzymes are the symptoms of indigestion, fever, redness, swelling, pain, and abnormal joint movement. We see them every day.

Turning now to the other necessary ingredients in food -- protein, carbohydrate, and lipids -- the presence of a deficiency of these ingredients must first be determined before the need for dietary modification may be evaluated.

Such a condition can occur from inadequate ingestion of a particular food substrate or from the inability to digest adequate amounts of that substrate. Completely different clinical syndromes arise from a protein deficiency caused by fasting than would be seen with excessive intake of protein accompanied by inadequate digestion.

It's worth noting that the pharmaceutical approach to health care does not provide "magic bullets" for the early warning signs of a protein, carbohydrate, or lipid deficiency. Advanced states such as kwashiorkor and sprue are recognized, why not the early warning signs?

Quite simply, the body can tear down its own tissues to get protein, carbohydrate (as glucose), and lipids when they are needed. All three food substrates are necessary to maintain health, but protein clearly is the most important among equals. Plasma proteins are primarily responsible for maintaining homeostasis.

Both protein and lipids can be converted to glucose when needed for energy, but glucose and lipids cannot be converted to protein. Early signs of deficiency escape detection, so that's the place to begin. What symptoms would suggest a look at diet as a possible cause of a patient's symptoms?

First, I will list common symptoms that should indicate that a patient requires dietary modification.

These are general symptoms, in no way indicating what type of dietary change is needed. The point is, patients seldom recognize them as dietary problems and instead seek over-the-counter relief. Even medicine rarely looks for the cause of these symptoms but instead uses drug intervention to cover:

*** Heartburn, gas and bloating

*** Constipation or diarrhea

*** Irritability, restlessness, and insomnia

*** Inability to tolerate stress (bad temper or even road rage)

*** Anxiety or depression

*** Stiff, sore joints

*** Tachycardia

We all see a lot of the above problems in our offices, but how many times do we look for a dietary cause and correction?

Getting more specific in the search for diet-related symptomatology, what symptoms best represent the need for improved ingestion, digestion, or assimilation of protein, carbohydrate, or lipids?

1. Decreased secretions from the mouth, nose, and eyes

2. Muscle weakness

3. Inability to concentrate

4. Easily startled

5. Difficulty swallowing

6. Voice affected by stress

1. Increased secretions from the mouth, nose, and eyes

2. Edema of the hands and feet

3. Muscle and/or menstrual cramps

4. Low tolerance for exercise

5. Cold hands and feet

6. Bleeding gums

Early lipid deficiency signs

1. Dry skin.

2. Tremors of the hands, especially in the elderly and alcoholics.

3. Perhaps most important -- and most overlooked -- is the development of prostaglandin deficiencies, for which fatty acids are the precursors. This may be responsible for an inability to control blood pressure, the inability to conceive, inability to carry a fetus to full term, and the inability to initiate labor.

While not definitive, these lists of symptoms may cause you to take a second look at your patients' diets, especially in those difficult cases.

Coming up: An expanded look at diet-related problems through examining the functions of protein, carbohydrates, and lipids.