This can occur due to a problem known as functional vitamin B12 deficiency — where there's a problem with the proteins that help transport vitamin B12 between cells. This results in neurological complications involving the spinal cord.
Folate dissolves in water, which means your body is unable to store it for long periods of time. Your body's store of folate is usually enough to last four months. This means you need folate in your daily diet to ensure your body has sufficient stores of the vitamin. Like vitamin B12 deficiency anaemia, folate deficiency anaemia can develop for a number of reasons.
Some are described below. Good sources of folate include broccoli, Brussels sprouts, asparagus, peas, chickpeas and brown rice. If you don't regularly eat these types of foods, you may develop a folate deficiency. Folate deficiency caused by a lack of dietary folate is more common in people who have a generally unbalanced and unhealthy diet, people who regularly misuse alcohol and people following a fad diet that doesn't involve eating good sources of folate.
Sometimes your body may be unable to absorb folate as effectively as it should. This is usually due to an underlying condition affecting your digestive system, such as coeliac disease. You may lose folate from your body if you urinate frequently. This can be caused by an underlying condition that affects one of your organs, such as:.
Some types of medicine reduce the amount of folate in your body, or make the folate harder to absorb. These include some anticonvulsants medication used to treat epilepsy , colestyramine, sulfasalazine and methotrexate. Your GP will be aware of medicines that can affect your folate levels and will monitor you if necessary.
Your body sometimes requires more folate than normal. This can cause folate deficiency if you can't meet your body's demands for the vitamin. Premature babies born before the 37th week of pregnancy are also more likely to develop a folate deficiency, because their developing bodies require higher amounts of folate than normal.
If you're pregnant or trying to get pregnant, it's recommended that you take a microgram folic acid tablet every day until you're 12 weeks pregnant. This will ensure that both you and your baby have enough folate and help your baby grow and develop. Folic acid tablets are available with a prescription from your GP, or you can buy them over the counter from pharmacies, large supermarkets and health food stores. If you're pregnant and have another condition that may increase your body's need for folate, such as those mentioned above, your GP will monitor you closely to prevent you from becoming anaemic.
In some cases, you may need a higher dose of folic acid. For example, if you have diabetes, you should take a 5 milligrams 5mg supplement of folic acid instead of the standard micrograms. Read more about vitamins and minerals in pregnancy. A diagnosis of vitamin B12 or folate deficiency anaemia can often be made by your GP based on your symptoms and the results of blood tests.
Different types of blood tests can be carried out to help identify people with a possible vitamin B12 or folate deficiency. These tests check:. However, some people can have problems with their normal levels of these vitamins or may have low levels despite having no symptoms.
This is why it's important for your symptoms to be taken into account when a diagnosis is made. A particular drawback of testing vitamin B12 levels is that the current widely-used blood test only measures the total amount of vitamin B12 in your blood.
This means it measures forms of vitamin B12 that are "active" and can be used by your body, as well as the "inactive" forms, which can't. If a significant amount of the vitamin B12 in your blood is "inactive", a blood test may show that you have normal B12 levels, even though your body can't use much of it.
There are some types of blood test that may help determine if the vitamin B12 in your blood can be used by your body, but these aren't yet widely available. If your symptoms and blood test results suggest a vitamin B12 or folate deficiency, your GP may arrange further tests. If the cause can be identified, it will help to determine the most appropriate treatment. For example, you may have additional blood tests to check for a condition called pernicious anaemia.
This is an autoimmune condition where your immune system produces antibodies to attack healthy cells , which means you're unable to absorb vitamin B12 from the food you eat. Tests for pernicious anaemia aren't always conclusive, but they can often give your GP a good idea of whether you have the condition. A dietitian can devise a personalised eating plan for you to increase the amount of vitamin B12 or folate in your diet. The treatment for vitamin B12 or folate deficiency anaemia depends on what's causing the condition.
Most people can be easily treated with injections or tablets to replace the missing vitamins. Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, in a form called hydroxocobalamin.
At first, you'll have these injections every other day for two weeks, or until your symptoms have stopped improving. Your GP or nurse will give the injections. After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet.
The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which isn't related to your diet. Read more about the causes of vitamin B12 or folate deficiency. If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals.
Alternatively, you may need to have an injection of hydroxocobalamin twice a year. People who find it difficult to get enough vitamin B12 in their diets, such as those following a vegan diet, may need vitamin B12 tablets for life.
Although it's less common, people with vitamin B12 deficiency caused by a prolonged poor diet may be advised to stop taking the tablets once their vitamin B12 levels have returned to normal and their diet has improved.
If you're a vegetarian and vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract including Marmite , as well as some fortified breakfast cereals and soy products.
Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain. If your vitamin B12 deficiency isn't caused by a lack of vitamin B12 in your diet, you'll usually need to have an injection of hydroxocobalamin every three months for the rest of your life. If you've had neurological symptoms symptoms that affect your nervous system, such as numbness or tingling in your hands and feet caused by a vitamin B12 deficiency, you'll be referred to a haematologist, and you may need to have injections every two months.
Your haematologist will advise on how long you need to keep taking the injections. For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin. This is because hydroxocobalamin stays in the body for longer.
If you need regular injections of vitamin B12, cyanocobalamin would need to be given once a month, whereas hydroxocobalamin can be given every three months. Cyanocobalamin injections aren't routinely available on the NHS. However, if you need replacement tablets of vitamin B12, these will be cyanocobalamin. To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels.
They may also give you dietary advice so you can increase your folate intake. Most people need to take folic acid tablets for about four months. However, if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer — possibly for life. Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they're normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency.
To ensure your treatment is working, you may need to have further blood tests. A blood test is often carried out around days after starting treatment to assess whether treatment is working. This is to check your haemoglobin level and the number of the immature red blood cells reticulocytes in your blood.
Another blood test may also be carried out after approximately eight weeks to confirm your treatment has been successful. If you've been taking folic acid tablets, you may be tested again once the treatment has finished usually after four months. Most people who have had a vitamin B12 or folate deficiency won't need further monitoring unless their symptoms return, or their treatment is ineffective. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information.
Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Updated visitor guidelines. Top of the page. Topic Overview What is vitamin B12 deficiency anemia? What causes vitamin B12 deficiency anemia? This can happen if: You have pernicious anemia. In this anemia, your body destroys the cells in your stomach that help you absorb vitamin B You have had surgery to remove part of the stomach or the last part of your small intestine, called the ileum.
This includes some types of surgery used to help very overweight people lose weight. You have problems with the way your body digests food, such as sprue also called celiac disease , Crohn's disease , bacteria growth in the small intestine, or a parasite. What is the recommended daily amount of vitamin B12? The amount of vitamin B12 you need depends on your age. Daily recommended B footnote 1 Age years Daily amount of B12 micrograms 1—3 0. As the anemia gets worse, you may: Feel weak, tired, and lightheaded.
Have pale skin. Have a sore, red tongue or bleeding gums. Feel sick to your stomach and lose weight. Have diarrhea or constipation. If this happens, you may have: Numbness or tingling in your fingers and toes. A poor sense of balance. A decrease in mental abilities. How is vitamin B12 deficiency anemia diagnosed?
How is it treated? Can vitamin B12 deficiency anemia be prevented? Dietary reference intakes DRIs : Recommended dietary allowances and adequate intakes, vitamins. Other Works Consulted Carmel R Cobalamin Vitamin B In ME Shils et al. Philadelphia: Lippincott Williams and Wilkins. Red blood cells carry oxygen from your lungs throughout your body. If your diet is lacking in certain vitamins, vitamin deficiency anemia can develop. Or vitamin deficiency anemia may develop because your body can't properly absorb the nutrients from the foods you eat.
Folate, also known as vitamin B-9, is a nutrient found mainly in fruits and leafy green vegetables. A diet consistently lacking in these foods can lead to a deficiency. Deficiency can also result if your body is unable to absorb folate from food.
Most nutrients from food are absorbed in your small intestine. You might have difficulty absorbing folate or folic acid, the synthetic form of folate that's added to foods and supplements, if:. Pregnant women and women who are breast-feeding have an increased demand for folate, as do people undergoing dialysis for kidney disease.
Failure to meet this increased demand can result in a deficiency. Vitamin B deficiency can result from a diet lacking in vitamin B, which is found mainly in meat, eggs and milk. However, the most common cause of vitamin B deficiency anemia is a lack of a substance called intrinsic factor, which can be caused when your immune system mistakenly attacks the stomach cells that produce this substance.
This type of anemia is called pernicious anemia. Intrinsic factor is a protein secreted by the stomach that joins vitamin B in the stomach and moves it through the small intestine to be absorbed by your bloodstream. Without intrinsic factor, vitamin B can't be absorbed and leaves your body as waste. People with endocrine-related autoimmune disorders, such as diabetes or thyroid disease, may have an increased risk of developing pernicious anemia.
Vitamin B deficiency anemia can also occur if your small intestine can't absorb vitamin B for reasons other than a lack of intrinsic factor. This may happen if:. Vitamin C deficiency can develop if you don't get enough vitamin C from the foods you eat. Vitamin C deficiency is also possible if something impairs your ability to absorb vitamin C from food. For instance, smoking impairs your body's ability to absorb vitamin C.
Certain chronic illnesses, such as cancer or chronic kidney disease, also increase your risk of vitamin C deficiency anemia by affecting the absorption of vitamin C.
A number of factors can affect your body's vitamin stores. In general, your risk of vitamin deficiency is increased if:. Your diet contains little to no natural vitamin food sources, such as meat, dairy, fruits and vegetables. Vegetarians who don't eat dairy products and vegans, who don't eat any foods from animals, may fall into this category. Pregnant women with folate deficiency may be more likely to experience complications, such as premature birth.
A developing fetus that doesn't get enough folate from its mother can develop birth defects of the brain and spinal cord. If you're thinking of becoming pregnant, ask your doctor whether you should consider taking folic acid supplements so that your body's stores of folate will be enough to support your baby.
While vitamin B is important for the production of red blood cells, it's also important for a healthy nervous system.
Untreated, vitamin B deficiency can lead to neurological problems, such as persistent tingling in your hands and feet or problems with balance.
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