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Nutrient deficiency in Sweden: what the numbers actually show

In the spring of 2010, 1797 adults in Sweden started writing down everything they ate and drank for four days at a time. The result, Riksmaten vuxna 2010-11, is still the reference picture of what people in Sweden actually eat. When Livsmedelsverket added up the nutrients, three of them came out consistently low: vitamin D, folate and iron. Magnesium and vitamin C, which get far more attention, were not among them.

That turns a vague worry about nutrient deficiency into a short list. Here we go through the figures nutrient by nutrient, what separates a low intake from a deficiency in your own blood, and how we at Health Royals used the same figures when we built a daily multivitamin for women. The survey has limits, which we note where they matter.

The short version

• Riksmaten vuxna 2010-11 names three nutrients that come out low in Sweden: vitamin D, folate and iron, with selenium as a fourth once the current Nordic reference values are applied. Magnesium and vitamin C are not on the list.

• A low intake is a statement about a group, a deficiency is something measured in one person's blood. Among women of childbearing age, 29 percent had depleted iron stores, 20 percent insufficient vitamin D status and 3 percent low folate. Food containing less nutrition than before is a plant breeding story, not the explanation for the Swedish gaps.

• Health Royals Peak Performance Formula, a daily multivitamin for women, is built around exactly this list: 25 µg vitamin D3 as Quali-D®, 200 µg folate as Quatrefolic®, 27.5 µg selenium and 375 mg omega 3 from algae per daily dose. It contains no iron, because iron for women is a question for a blood test. Folate contributes to the reduction of tiredness and fatigue.

Health Royals Peak Performance, supplement with vitamin D3, K2 as MenaQ7, folate as Quatrefolic and omega-3 from algal oil

Vitamin D, folate and selenium at Health Royals

Peak Performance is one jar built around the nutrients Swedish intakes more often run low on: 25 µg vitamin D3 as Quali-D®, 200 µg folate as Quatrefolic® 5-MTHF, 27.5 µg selenium and OMEGATEX® algal oil giving 375 mg omega 3, with K2 as MenaQ7® and B12 as MecobalActive®. Vitamin D contributes to the normal function of the immune system. Selenium contributes to normal thyroid function. Iron is not included, and a suspected iron deficiency is a question for a blood test.

See Peak Performance, multivitamin for women with omega 3

Which nutrients do people in Sweden actually get too little of?

Vitamin D, folate and iron, with selenium as a fourth once the current Nordic reference values are applied.

Livsmedelsverket's own short version of Riksmaten says it plainly: the nutrients that are hardest to get enough of are vitamin D, iron and folate, and intake is lowest of all among young women, who eat less fish, vegetables and fruit than average and drink more soft drinks.

The yardstick is the Nordic Nutrition Recommendations 2023, which sets 10 micrograms of vitamin D a day for adults, 330 micrograms of folate, 15 mg of iron for women aged 18 to 50 against 9 mg for men, and an adequate intake of 75 micrograms of selenium for women and 90 for men. Livsmedelsverket's Swedish summary of the same values raises vitamin D to 20 micrograms for women over 70.

What is the difference between a low intake and an actual nutrient deficiency?

A low intake is a statement about a group, a deficiency is something measured in one person's blood, and the two line up less neatly than people assume.

The recommended intake is set high enough to cover almost everyone in a healthy population, so an individual below it is not thereby deficient. The average requirement is the level around half the group would need, and a group whose median sits below that is a real signal.

Riksmaten included a subsample who also gave blood and urine. Among women of childbearing age, 29 percent had depleted iron stores, 20 percent had insufficient vitamin D status and only 3 percent had low folate concentrations. The folate gap that looks severe in the intake data largely did not appear in the blood.

Symptoms are less specific: tiredness, poor concentration, brittle nails and hair that sheds more than usual have many other causes, and a blood test through healthcare gives the answer a symptom list cannot.

What we do know is just as useful: the nutrients that run low in Sweden can be named in advance, and a daily intake of them does not need to wait for a symptom. Vitamin B12 is a case of its own, covered in B12 deficiency: signs and tests. Magnesium is not on Riksmaten's list, and how common magnesium deficiency actually is has its own article.

Why is vitamin D the clearest case in Sweden?

Because two thirds of adults eat less than the average requirement, while about one fifth show low levels in the blood.

Livsmedelsverket's 2018 risk and benefit report on vitamin D supplements gives the Riksmaten figures precisely: 67 percent of adults had an estimated dietary vitamin D intake below the average requirement of 7.5 micrograms per day, and 19 percent had an intake above the recommended 10 micrograms. Measured as blood status, around 20 percent of participants were below 50 nmol per litre.

The distance between the two figures is sunlight. Skin synthesis during the Swedish summer covers part of what the diet does not. On that basis the agency recommends supplements for defined risk groups, including young children, people over 75 and those who avoid sun exposure or do not eat fish and fortified foods. From October to March the skin in Sweden makes no vitamin D at all, so a daily intake through the dark half of the year is a reasonable habit. Our article on vitamin D deficiency and the Swedish winter goes through symptoms and doses.

Vitamin D contributes to normal muscle function and to the normal function of the immune system. Peak Performance carries 25 µg of vitamin D3 as Quali-D® from dsm-firmenich, a deliberate middle ground for every day of the year: above the Nordic 10 µg because the skin makes none in winter, and a quarter of the upper level. More is not better, so we stopped there.

Do women of fertile age in Sweden have iron deficiency, and what about folate?

Close to a third of them had empty iron stores when it was measured, which is the largest confirmed shortfall in the Swedish data.

In the Riksmaten biomarker subsample, 29 percent of women aged 18 to 44 had depleted iron stores. The recommended intake of 15 mg a day for women aged 18 to 50, against 9 mg for men, exists because of menstrual losses. Iron contributes to normal formation of red blood cells and haemoglobin and to normal oxygen transport in the body.

Iron is the one nutrient on this list we deliberately left out of Peak Performance: iron status varies too much between women for one fixed dose to suit everyone, so for us it is a question for a blood test, and any iron supplement is best chosen with the result in hand.

Folate sits beside iron in the same group, and its sources are more specific than most people assume. A study of 1657 Riksmaten participants found that vegetables and pulses were the single most important folate source for every age group and both sexes, accounting for 49.7 percent of total folate intake among women aged 45 to 64. The folate in Peak Performance is 200 µg as Quatrefolic®, the 5-MTHF form from Gnosis by Lesaffre, the form that circulates in the blood, at a nutritional level. Folate contributes to the reduction of tiredness and fatigue.

Do people in Sweden get enough selenium?

No, and measured against the current reference values the gap is proportionally wider than for vitamin D.

The NNR2023 scoping review on selenium compiled national figures: selenium intake in Sweden is about 50 micrograms a day for men and 42 for women. The adequate intake in NNR2023 is 90 micrograms for men and 75 for women, and even the provisional average requirement, 70 and 60, sits above what Swedes actually eat. Across the Nordic and Baltic countries intakes range from 39 to 88 micrograms in men and 22 to 68 in women.

Two things explain that. The first is geology: Nordic soils are naturally low in selenium, Finland corrects this by adding selenium to fertiliser and the other Nordic countries add it to animal feed. The second is that NNR2023 raised the selenium reference value, so part of the apparent shortfall reflects a moved goalpost rather than a change in what people eat.

Selenium contributes to normal thyroid function and to the protection of cells from oxidative stress. Peak Performance contains 27.5 µg of selenium as L-selenomethionine, an organic form, at a nutritional level. For us the dose is as important as the raw material, and a modest daily amount is the point.

Why does Peak Performance contain exactly what Riksmaten points to?

Because a daily multivitamin for women in Sweden should start from what women in Sweden actually eat, not from a list of everything that fits in a capsule.

Our starting point at Health Royals is fewer jars and more thought: every ingredient needs a reason to be there, and for the vitamins and minerals in Peak Performance that reason came from the intake data above. Beside vitamin D3, folate and selenium sits OMEGATEX® algal oil, 500 mg, giving 375 mg of omega 3 from algae, of which 300 mg DHA and 50 mg EPA, because a diet short on vitamin D and selenium is usually a diet short on fish, and omega 3 is the part most multivitamins leave out. DHA contributes to the maintenance of normal brain function, and EPA and DHA contribute to the normal function of the heart.

Around that core sit vitamin K2, 90 µg, as MenaQ7®; vitamin B12, 10 µg, as MecobalActive® methylcobalamin; thiamine, niacin, chromium and zinc as L-OptiZinc®; and two named plant extracts, Hytolive® olive fruit extract, 150 mg, giving 15 mg hydroxytyrosol, and Extramel® melon extract, 10 mg, both at the daily amount used in their human studies. The vitamins and minerals sit at a nutritional level, not a study level. Vitamin B12 contributes to the reduction of tiredness and fatigue. Not in the jar: iron, for the reason above, and magnesium and calcium, because neither appears among the Swedish shortfalls.

A named raw material from a specialist manufacturer, at an amount we can explain, is what we mean by a considered selection; why the name matters is the subject of our article on branded ingredients. The jar is amber glass with a scent core, made to stand on the counter, because a daily nutrient only helps on the days it is taken, and the subscription sends refill pouches after the first jar.

Is it true that food contains less nutrition than it used to?

There is real data behind the claim, and it is narrower than it sounds when repeated.

The paper usually cited is Davis and colleagues, 2004, which compared USDA food composition data for 43 garden crops between 1950 and 1999. Median declines ranged from 6 percent for protein to 38 percent for riboflavin, with calcium, phosphorus, iron and ascorbic acid also lower. The authors' own conclusion: any real declines are most easily explained by changes in cultivated varieties between 1950 and 1999, in which there may be trade-offs between yield and nutrient content.

The older reference is Mayer, 1997, in the British Food Journal, which compared UK food composition tables published decades apart and reported lower mineral content in a number of fruits and vegetables.

The strongest single dataset is not from a composition table at all. Fan and colleagues, 2008 used archived wheat grain from the Broadbalk field experiment at Rothamsted, sampled continuously since 1845. Zinc, iron, copper and magnesium stayed stable from 1845 to the mid 1960s, then decreased significantly. Increasing yield and harvest index explained the downward trend, and the timing coincides with the introduction of semi-dwarf, high yielding cultivars. Soil mineral concentrations did not fall. This is a plant breeding story, not a soil exhaustion story. For Sweden that is reassuring: the gaps come from diet and latitude, and both can be acted on.

How have eating habits in Sweden changed?

Fish and fruit have lost ground, and vegetables have slipped back since 2013.

In Folkhalsomyndigheten's national survey, the share of adults eating vegetables and root vegetables at least twice a day rose from 27 percent in 2004 to 37 percent in 2013 and then fell back to 31 percent in 2024. Fruit and berries at least twice a day fell from 34 percent in 2004 to 22 percent in 2024. Fish and shellfish at least twice a week fell from 30 percent in 2016 to 21 percent in 2024. Fish is a main dietary source of both vitamin D and selenium in this country.

Which foods make the most difference, and where does food stop?

The four nutrients that are genuinely low in Sweden come from a short and slightly unusual list.

  • Fatty fish, twice a week, is the only ordinary food that delivers meaningful vitamin D and selenium in the same portion.
  • Eggs and fortified dairy carry most of the remaining dietary vitamin D in the Swedish diet, which is why the intake figures fall when milk consumption does.
  • Pulses and leafy greens are the main folate source, and gentle cooking keeps more of it than a long boil.
  • Iron from meat and fish is absorbed more readily than iron from plants, and a source of vitamin C in the same meal improves absorption from the plant sources.
  • Whole grains, eggs and fish supply most dietary selenium in a country whose soils supply little.

Food is the bigger lever, and a supplement does not replace a varied diet. What food cannot fix is the Swedish winter, where Livsmedelsverket's own risk group advice sits, and the weeks when fish, pulses and greens do not make it to the table. More of our writing on this is collected under wellbeing.

Peak Performance, multivitamin for women with omega 3, lists vitamin D3 at 25 µg, folate as Quatrefolic® at 200 µg, selenium at 27.5 µg and omega 3 from algae at 375 mg per daily dose, so that any comparison you make is a comparison of numbers rather than adjectives. We have done the selection so that you do not have to.

Further reading

Frequently asked questions

Which nutrients do people in Sweden actually get too little of?
Vitamin D, folate and iron according to Riksmaten, and selenium once measured against NNR 2023. Intake is lowest among young women, who eat less fish, vegetables and fruit than average. Magnesium and vitamin C are not among the documented shortfalls.

Can symptoms tell me I have a nutrient deficiency?
Not on their own. Tiredness, poor concentration, brittle nails and shedding hair have many other causes, and a blood test through healthcare answers the question. What can be said in advance is which nutrients run low in Sweden, and a daily intake of those does not need to wait for a symptom.

Do I need a supplement if I already eat a varied diet?
More fish, pulses and greens is the bigger lever, and a supplement does not replace them. What food cannot fix is the Swedish winter, where Livsmedelsverket's own risk group advice sits. Peak Performance is built around the nutrients Riksmaten points to, without iron, which is a question for a blood test.

How reliable is Riksmaten?
Good enough to name the nutrients. Only 36 percent of those invited took part, and Livsmedelsverket itself states that the low participation rate may have influenced the results, especially for young men. Four day food records also tend to under-report intake.

Sources