What is anemia?
Anemia is a below-normal level of hemoglobin* or hematocrit*. Hemoglobin is the substance in red blood cells that carries oxygen to all parts of your body. Anemia can be temporary or it can be a long-term disease/illness. People with mild anemia may not have any symptoms or may have only mild symptoms. People with severe anemia can feel tired, get short of breath with activity, and have problems doing the things they usually do.¹

How common are these vitamin deficiencies?
These problems are most common in older adults, particularly those who have lost interest in eating and live on “tea and toast” or other restricted diets. One study showed that 13% of adults ages 65 to 100 have vitamin B₁₂ deficiency. Another study found that 5% of healthy older adults have low folate (vitamin B₉). Vegetarians may also be prone to vitamin B₁₂ deficiency due to the lack of meat in their diet.

What is vitamin deficiency anemia?
Folate, vitamin B₆, vitamin B₁₂, and vitamin C are the vitamins needed for a body to produce healthy red blood cells. Not having enough of one or more of these vitamins may cause anemia.

What causes deficiency (low levels) of these vitamins?
Low vitamin B₆ is usually due to not eating enough foods that contain B₆. Good sources of vitamin B₆ are meat, liver, cereal grains, bananas, and nuts. Certain medications can also cause vitamin B₆ deficiency.⁴ Folate deficiency is often caused by an unbalanced diet that does not include enough fresh fruits and green, leafy vegetables. Other common causes of vitamin deficiency anemia are pregnancy, breastfeeding, alcohol abuse, and growth spurts.

Vitamin B₁₂ deficiency develops when your body is not able to absorb this vitamin. This can be caused by medication, stomach or bowel surgery, and certain diseases. Sometimes vitamin B₁₂ deficiency occurs in strict vegetarians and people who do not eat much meat, milk, or eggs.⁵ In older people, the most common cause of vitamin B₁₂ deficiency is not having enough gastric juice to get the B₁₂ out of the food you eat. This is known as achlorhydria. Vitamin deficiency also develops when a person’s diet does not include enough citrus fruits and other sources of essential vitamins.

What are the effects of these vitamin deficiencies?
Long-lasting deficiency of vitamin B₆, folate, or vitamin B12 can result in anemia. With folate and vitamin B₁₂ deficiency, anemia often causes symptoms such as fatigue, poor appetite, weight loss, and diarrhea. The earliest symptoms of vitamin B₁₂ deficiency may be weakness, poor coordination, numbness, and a “pins and needles” feeling in the arms and legs. Mild irritability and forgetfulness are other early signs. A severe untreated deficiency can result in serious damage to the nerves, spinal cord, and brain. Vitamin C helps your body absorb iron, and low levels can result in anemia.

How do I know if I am anemic?
Most people do not realize they are anemic until a blood test shows a low hemoglobin or hematocrit. Symptoms and signs usually develop when anemia is moderate to severe, and can include fatigue, weakness, pale skin, chest pain, dizziness, irritability, numbness or coldness in your hands and feet, trouble breathing, a fast heartbeat, and headache. It is important to see your doctor on a regular basis in order to be tested for possible anemia.

What treatments are available to help me?
Your doctor will provide the treatment that is best for you based on what is causing the anemia. Several medications are approved to help correct anemia, and in certain cases mild anemia due to vitamin deficiencies may be corrected with a change in diet. Folate deficiency in pregnant women can cause serious birth defects, and many processed foods are fortified with folic acid, the manufactured form of naturally occurring folate. Close communication with your doctor will ensure you will receive the best anemia treatment available.

*Normal Lab Values: Normal hemoglobin >= 12 g/dL for women, >= 14 g/dL for men; normal hematocrit >= 36% for women, >= 42% for men.

References

1. National Anemia Action Council. Anemia: A Hidden Epidemic. Los Angeles, CA: HealthVizion Communications, Inc; 2002.
2. Rajan S, et al. J Am Geriatr Soc. 2002;50:624-630.
3. Joosten E, et al. Am J Clin Nutr. 1993;58:468-476.
4. Office of Dietary Supplements, NIH. Dietary supplement Fact Sheet. Available at: ods.od.nih.gov.
5. Babior BM, Bunn HF. Megaloblastic anemias. Available at: www.harrisonspractice.com.

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