Vitamin B12 & Folate deficiency
In India, more than 10 million cases of vitamin B12(cobalamine) deficiency and more than 1 million cases of folate (Vitamin B9) deficiency are seen in a year. Vitamin B12 regulates the nervous system and helps in production of red blood cells. Vitamin B9 also helps in production of red blood cells and prevents birth defects. Deficiency of both B12 and B9 results in anemia. Deficiency of B12 also affects the nervous system and cause nerve damage (peripheral neuropathy).
Causes for Vitamin B12 & Folate deficiency
Deficiency is seen when a diet having inadequate B12 is consumed and when absorption is decreased. The following conditions reduce the absorption of B12
- Age (>50 years)
- Stomach ulcers
- Weight loss surgeries
- Immune system disorders
- Pernicious anemia
- Few medications for indigestion, diabetes, heart burn and ulcers
- Digestive conditions such as crohn’s disease
Folic acid deficiency can be caused if folic acid deficient diet is consumed or absorption is reduced. Pregnant women require folate supplements as for the healthy growth and development of the fetus. Folic acid deficiency during pregnancy can cause birth defects such as spina bifida.The following conditions can result in reduced absorption of folate.
- Hereditary of decreased folate absorption
- Medications like methotrexate, triamterene, pyrimethamine, trimethoprim-sulfamethoxazole and barbiturates.
|Recommended dietary allowance|
|Age||B12 (mcg/day)||B9 (mcg/day)|
Vitamin B12 and folate deficiency causes anemia. The following are the symptoms associated with the deficiency:
- Pale skin
- Mouth ulcers
- Red and swollen tongue
- Ringing in ears
- Lack of appetite
- Shortness of breath
Specific symptoms associated with nerve damage caused by B12 deficiency are as follows
- Tingling sensation
- Difficulty in walking
- and alteration in sensing touch
Diagnosis of Vitamin B12 and B9 deficiency
The first test for determining vitamin B12 and B9 deficiency is a blood test. In B9 deficiency, folate levels in plasma or RBC are determined. The following tables shows the reference values of Vit. B12 and folate
|B12 Level (pg/ml)|
|200 to 600||Normal|
|Folate in plasma (ng/ml)|
|Folate in RBC (ng/ml)|
A complete blood picture is done to find out hemoglobin levels and check the size and shape of red blood cells. In B12 and B9 deficiency, homocysteine and methylmelonic acids (MMA) levels are also determined. Homocysteine and MMA are elevated in B12 deficiency while only homocysteine, (and not MMA), is elevated in folate deficiency.
Assessment of Nerve damage (Peripheral neuropathy):
Diagnosis of nerve damage or peripheral neuropathy associated with Vitamin B12 deficiency can be assessed by the following techniques:
- Neurological exam: This includes assessment of muscle strength, tendon reflexes, sensation, posture and coordination.
- Nerve function tests: It includes electromyography recording, autonomic reflex screen, sweat tests and sensory tests.
Treatment for Vitamin B12 and B9 deficiency
Vitamin B12 and B9 deficiency can be treated by having a diet which has adequate amount of B12 & B9. Vitamin B12 is found in meat, fish, eggs, dairy products, yeast extract and specially fortified foods. B9 or folate is present in green vegetables such as broccoli, Brussels sprouts and peas.
Supplements are also given to treat Vitamin B12 and B9 deficiency. Supplements can be stopped once the deficiency is overcome.
Nerve damage due to vitamin B12 deficiency is permanent. Early diagnosis of vitamin B12 deficiency can prevent it.
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- The Symptoms of Vitamin B Deficiency. https://www.healthline.com/health/symptoms-of-vitamin-b-deficiency#preventingdeficiency7. Accessed on 24-Oct-2017
- What Is Folic Acid Deficiency Anemia. https://www.webmd.com/a-to-z-guides/folic-acid-deficiency-anemia#1-2. Accessed on 24-Oct-2017.
- Vitamin B12: What to Know .https://www.webmd.boots.com/healthy-eating/guide/vitamin-b12-deficiency.Accessed on 24-Oct-2017.
- Vitamin B12. https://familydoctor.org/vitamin-b-12/..Accessed on 24-Oct-2017
- Vitamin B9 Intake Recommendations. http://www.nutri-facts.org/en_US/nutrients/vitamins/b9/intake-recommendations.html. Accessed on 24-Oct-2017. Accessed on 24-Oct-2017
- Vitamin B12: What to Know.https://www.webmd.com/diet/vitamin-b12-deficiency-symptoms-causes#2. Accessed on 24-Oct-2017
- Peripheral neuropathy. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/diagnosis-treatment/drc-20352067. Accessed on 24-Oct-2017