Home HEALTH ASK THE DOCTOR David Wartenberg, M.D.

David Wartenberg, M.D.


Tell-Tale Signs of a Vitamin Deficiency


Nutritional deficiencies gone undetected over long periods can lead to life-altering health complications. Different areas of your body may present signs that signal something is physiologically wrong. That’s why being in tune with your body’s needs and being aware of these signs of nutritional deficiencies are critical to living a healthy life.

Dr. David Wartenberg, a board-certified family physician at Tulane Doctors – Primary Care –Metairie, has a special interest in identifying the presence and treatment of vitamin and nutritional deficiencies, and minimizing polypharmacy to prevent uncomfortable and dangerous adverse drug reactions and drug interactions.

With more than 20 years of clinical and academic experience, he explains why it is important for primary care physicians and medical providers to check for vitamin deficiencies. “Your body requires optimal vitamins and minerals to help eliminate toxins,” he says. “Vitamins and minerals promote the health needs of your digestive system, cardiovascular system, metabolism and total body strength. When there is an imbalance, either a vitamin deficiency or over-consumption, there are external and internal signs. If you detect something is wrong, make an appointment with your primary care doctor so that you can realign your balance for optimal health.”

There are five body signs of nutritional deficiencies: hair loss and skin rash; oral health problems; muscular cramps in your legs; itchy rashes; acne or blemishes; and/or abnormal sensations in your hands or feet.

The Importance of Vitamin D
There is evidence that vitamin D may have wide-ranging benefits. Most of these benefits are the result of the vitamin’s absorption-related duties, however, there may be more of a direct effect on disease processes and the immune system than previously believed. Studies have shown that too little vitamin D can pose health risks such as an increased risk of death from cardiovascular disease, cognitive impairment in older adults and severe asthma in children. Research also suggests that vitamin D could play a role in the prevention and treatment of a number of different conditions, including type 1 and type 2 diabetes, hypertension, glucose intolerance and multiple sclerosis.

“Symptoms of bone pain and muscle weakness can mean you have a vitamin D deficiency,” Dr. Wartenberg says. “However, for many people, the symptoms are subtle. Individuals that stay indoors may have a low level of vitamin D and not even be aware of it. If you don’t spend much time in the sun or if you are especially careful to cover your skin (sunscreen inhibits vitamin D production), you should speak to your doctor about taking a vitamin D supplement, particularly if you have risk factors for vitamin D deficiency.”

Vitamin D status is assessed through a simple blood test. The nutrition guidelines recommend that adults get 1,000 mg of 400 IU vitamin D daily. For 70-year-old adults and older, 600 IU of vitamin D is recommended.

Vitamin B12
Vitamin B12 is involved in the metabolism of every cell in the body. It is not only crucial for processes such as DNA synthesis and energy production, but it is critical for neurological, cardiovascular, digestive and immunological functions.

B12 deficiencies are a hidden epidemic in our society. It is one of the most common and overlooked conditions in the world. Strict vegans, who shun all animal-based products, sometimes struggle to get enough B12. For the most part, a vitamin B12 deficiency is not caused by a lack of intake. Typically a deficiency occurs because of shortages of substances inside the digestive system. Some people lack intrinsic factor, a protein made by stomach cells that are needed for B12 absorption,” Dr. Wartenberg says. “Individuals who take acid blockers [such as Zantac or Prilosec] are also at risk for a vitamin B12 deficiency because they impair the stomach’s ability to absorb.”

Many older people secrete fewer of the gastric juices that break down B12-containing compounds because they have atrophic gastritis (an inflammatory condition that affects the lining of the stomach). Deficiency may cause macrocytic anemia, a form of anemia that results in enlarged red blood cells. “For the elderly, it becomes a vicious cycle — the anemia may affect their balance and cognitive ability, which may lead to falls and fractures,” Dr. Wartenberg says. Symptoms of vitamin B-12 deficiency include having low energy, feeling tired, depression, anxiety, muscle pain, irritability, memory loss, and/or hearing and vision problems. “If you feel that your get up and go has got up and gone, the best thing to do is to come in and be evaluated,” he says.
Dr. Wartenberg performs many office-based procedures, including joint and trigger point injections, skin biopsies, mole removal, incision and drainage of abscesses. He enjoys caring for everyone from adolescents to the geriatric population and presently has patients aged 14 to 85 years old. “I consider myself a member of my patient’s healthcare team,” he says. “I want to educate them about their health so that they can live their best life.”

A native Northeasterner, Dr. Wartenberg made the South his home after graduating from the University of Alabama School of Medicine. After completing his family medicine residency at the University of Florida College of Medicine, Dr. Wartenberg remained in Florida in private practice for 20 years (in Jacksonville, Tampa and Pensacola Beach). In June 2018, he moved to New Orleans and accepted his current position as an assistant professor of medicine at Tulane School of Medicine.


Tulane Doctors – Primary Care – Metairie
2800 Veterans Memorial Blvd., Ste. 140
Metairie, LA 70002
(504) 988-0501

MEDICAL SCHOOL: University of Alabama at Birmingham School of Medicine
RESIDENCY: University of Florida College of Medicine – Family Medicine
ADDITIONAL MEDICAL TRAINING: University of Florida College of Medicine/Shands Hospital – Anesthesiology
BOARD CERTIFIED: American Board of Family Medicine