Updated: Jan 16, 2019
If you haven't yet come across Dr Bruce Ames and his ground-breaking Triage Theory, this is a must read. Everybody should be talking about this.
After tuning in to all 2 hours of Dr Ames' excellent presentation and Dr Rhonda Patrick's podcast on Triage Theory and micronutrients (and then descending into super intense research mode), I felt so inspired and outraged about the state of current nutrition science that I had to share it. And I hope you do, too.
Who is Dr Ames?
Dr Ames is an influential biochemist and prolific researcher and author. His research focuses on cancer and aging and delves into topics that aren't talked about, such as carcinogens in common house hold products. In the last 10 years, Dr Ames has devoted his incredible mind to the 'wonderfully muddy' (his words) field of human nutrition. He is currently the Director of the Nutrition and Metabolism Center at the Children's Hospital Oakland Research Institute.
The study that started it all ... and nobody paid attention
So, what sparked Dr Ames' curiosity (and at almost 70 years old) to shift his focus to nutrition? Dr Ames explains that a geneticist came to his lab about 20 years ago to study the effect of irradiation of mice on chromosomes. The geneticist was surprised to find that all of his control mice had the same chromosomal breaks as the experimental mice. How did this happen? After investigating the diet of the control mice, the geneticist discovered that the company that sold him the mice vitamin mix had mistakenly omitted folic acid from its ingredients. The result? The control mice suffered broken chromosomes due to folic acid deficiency, just like they would have if they had radiation. Their diet did the same thing as the treatment. Dr Ames remarks that this 1988 study 'changed nutrition ... but nobody paid any attention.' But he had an epiphany - 'Gee, half the poor population are at that level of folic acid ... maybe other vitamin and mineral deficiencies do that.' 
So Dr Ames started to investigate the 15 vitamins and 15 essential minerals that the human body needs to run its metabolism. If you don't have one (ie, it's absent), you die. Dr Ames found that the vitamins and minerals are mostly co-factors for enzymes - ie, our bodies use the vitamins and minerals to activate enzymes (made up of proteins) that trigger chemical reactions in our bodies.  For example, the most used vitamins and minerals include:
Zinc is in 2000 enzymes.
Magnesium is in 500 enzymes. You need magnesium to make and utilise ATP. But all DNA repair enzymes require magnesium too.
Calcium is integral to bone.
Selenium is in 25 enzymes.
Our bodies need all of these substances. Too much or too little is a bad thing. 
The body normally obtains these vitamins and minerals from plant food, because the plants take up the substances from soil. But soil today doesn't reliably contain the right amounts. So what happens if you're deficient?
What is Triage Theory?
The concept is just like a triage practice at a busy hospital - our body triages how it uses micronutrients. It prioritises the most important functions to meet its short term goals to stay alive and reproduce. If there's not enough of a micronutrient available, it is in nature's interests to ration it. Your body's priority is to put the vitamin and mineral in the proteins that will keep you alive. It neglects the enzymes that have cumulative effects, like DNA repair enzymes.
The immune system is a case in point. Dr Ames asks - why does the immune system decay as you age? He says that micronutrient deficiencies are to blame (for example, vitamin A, zinc, folate.) Basically, 'it's a way of saving your micronutrients by trashing your immune system.'
Dr Ames and other scientists conducted studies to test his theory. And sure enough, they found evidence of a rationing effect at play.
Dr Ames believes that this system of 'trading long term health for short term health' is true of all vitamins and minerals. If that's true, our bodies create vulnerable proteins and disable certain mechanisms in an attempt to meet our short term needs. And it is our longevity and vitality that suffers.
I find this theory utterly shocking and brilliantly simple. It's a wake up call for our age.
'Just because you're not walking around with acute deficiencies, doesn't mean that your getting enough micronutrients.'
- Dr Rhonda Patrick
How much of each vitamin and mineral do we need?
Our nutrient recommendations are based on science, but there's a catch. Dr Ames' points out that the Recommended Daily Intake (RDI) figures that we use today have their origins in historical, short term diseases. They are population based are set to prevent acute deficiencies that have an immediate impact in just hours, days, weeks and months. They don't reflect the quantities required for optimal long term function across years, decades and a life time.
Vitamin D is a prime example of this:
Dr Patrick explains that the RDI for vitamin D is 600 IU of vitamin D taken orally as a supplement.
The definition of vitamin D deficiency is 25-Hydroxy-Vitamin D (the precursor to Vitamin D) of less than 20 ng/ml (for Australian folk, that equates to less than 50 nmol/L).
It takes 1000 IU daily to raise blood levels by a meagre 5 ng/ml (12 nmol/L).
If you're very deficient, you'll struggle to raise your levels up to a sufficient level of 30 ng/ml or above (75 nmol/L) on that dosage. And that's just based on the current recommendations.
To add to the confusion - is this optimal? How much do we actually need? The RDI is based on a limited focus on the short term impact on your body's ability to absorb calcium and the risk of a disease like rickets. Dr Ames recommends a level of around 40 - 50 ng/ml (100 - 125 nmol/L).
Ok, so the RDI gives us something, but how do we know if we're getting enough for long term health? That, Dr Ames says, is the 'million dollar question.' We don't really know for sure.
Hold on - what's a 'longevity vitamin'?
Here's the kicker. It's not just the optimal quantities that we don't understand, it's the vitamins themselves. Science has defined its concepts and categories of vitamins and minerals based on the way that it approaches the study of micronutrients.
Dr Ames points out that science has identified these 30 vitamins and minerals based on an analysis of short term effects. He thinks that this needs to be reconsidered.
The emphasis is all on 'what kills you' if you don't have it. Practically no attention is paid to compounds that dictate diseases of aging, like antioxidant properties. Dr Ames believes that there are substances out there that are in fact vitamins, but we don't call them that. He describes this class as 'longevity vitamins'. For example, Dr Ames has identified carotenoids residing in the eye that, if deficient, contribute to degeneration.
It's a classic case of the question affecting the response. If you look for vitamins and minerals relevant to short term health, you will find precisely that. In the process, you may fail to see vitamins and minerals that are key to longevity and lasting health.
How do we meet our micronutrient needs?
Dr Ames focuses on food. He believes that a varied and balanced diet supplies enough vitamins and minerals to the body.
In contrast, an unbalanced diet high in refined foods certainly provides calories, but not nutrients. This has created a paradoxical state of affairs - for the first time in human history, Western society has managed to be simultaneously over fed and under nourished. Despite the abundance of food that is all around us and available at any time and place, the Standard American / Australian Diet (SAD) lacks the nutrients that our bodies need for cellular and general health. Some think that this could even cue our bodies to eat empty calories in vain to search for the missing nutrients that we need, and that this could be a factor in the rise of obesity rates. In effect, the obese body is 'starving' for nutrients and this could trump normal satiety signals and activate triage mechanisms. And there lies the conundrum of our age - constantly hungry, repeatedly eating, never satisfied.
'The obese are eating the worst diet in the country if you define worse as ratio of calories to essential micronutrients. They're just eating empty calories.'
- Dr Bruce Ames
Dr Ames' food suggestions
Eat your greens! The centre of the chlorophyll molecule contains vitamin K, magnesium and folic acid.
Nuts contain substances that promote health.
Fish: contains omega 3 fatty acids critical for brain function. Most people today have a 17:1 ratio of omega 3 to omega 6 fatty acids. It used to be 2:1. And it's vital to close that ratio because the fatty acids compete for the same enzymes in the body. Ie, you can't just bump up omega 3 and completely ignore the truck of omega 6 fatty acids that you dump into your blood stream each day. Reality check - that daily fried chicken is defeating your tiny morning teaspoon of fish oil.
'When you eat a bad diet, you're accelerating your aging in some way or another.'
- Dr Bruce Ames
How about supplements?
Dr Ames says that a multi vitamin could be used as 'insurance', but ultimately food is the premier source of our nutrients. He states that he takes fish oil, vitamin D, calcium, magnesium and a B complex, 'just to be sure'.
For vitamin D, you need sunshine! If you're not or can't be out in the sun, Dr Ames recommends a vitamin D pill. He takes 5000 IU daily. If you're deficient, measure your labs before and after attempts to use supplements increase it.
Dr Ames predicts that preventive and personalised medicine is the future for longevity and disease. If we're able to assess our unique nutrient deficiencies and genetic variability, this enables us to take that specific nutrient to address it. To accomplish this, it's important for us to rethink the way we approach nutrition. For example, many people have a gene polymorphism that means that they can't convert beta carotene into vitamin A, but they don't realise it. If you had this kind of information about your body at your finger tips, you could easily customise your food or supplement choices to seek out the nutrients that suit your body's needs.
Keen to learn more?
Listen to Dr Ames talk! Not only is he brilliant, but at 86 years old Dr Ames is witty, animated and generally a delight in a bow tie. He confesses that he 'seems to change his field every 10 to 15 years' and that he loves to read broadly and find areas that he can move into and make a contribution. He also admits that he still works full time and on Saturday afternoons, he says that he hopes he'll live until 90 because he has 'some big ideas to get out there before I kick off.' Now that's inspiring.
Dr Ames spruiks the excellent Linus Pauling Institute Micronutrient Information Center. It's a free, scientifically accurate information hub on the roles of vitamins, minerals, phytochemicals and other dietary factors in disease prevention and health promotion.
 Dr Ames explains why folic acid causes chromosome breaks in his discussion with Rhonda Patrick.
 Basically, enzymes make things happen in our bodies (for example, our bodies produce enzymes in the saliva in our mouths, our stomach, pancreas and intestines to digest and break down the foods we eat), and some enzymes can't function unless they have their trusty co-enzyme side kick.
 In terms of too much, Dr Ames says that for vitamins there's more room to move, but for minerals it's easier to have too much and ratios matter: ie, sodium to potassium, calcium to magnesium. Too much of one can be detrimental in the absence of the other.
 If you're interested, see Dr Patrick's pioneering work on vitamin D, tryptophan, serotonin and autism.
 People with darker skin (for example, lived in the tropics) put into a Northern latitude are more likely to be vitamin D deficient.