An update of vitamin B12 metabolism and deficiency states. High-risk groups for the deficiency syndrome include the elderly, patients taking ulcer medications over long periods, patients with acquired immunodeficiency syndrome, vegetarians, patients who have undergone stomach resection or small bowel resection, or both, and patients with dementia. The vitamin B12 deficiency syndrome is characterized by five stages, the fifth of which results in irreversible neuropsychiatric manifestations. Although the deficiency is easily treated, diagnosis is somewhat complicated by the shortcomings of the various tests. Vitamin B12 deficiency is treatable with monthly injections, large doses of daily oral supplement tablets, or an intranasal gel, which is far better absorbed than comparable oral supplements.
Anemia tends to develop among the poor, alcoholics, and pregnant women.
Deficiency leads to impaired cell division and to alterations in protein synthesis - the effects which are most pronounced in rapidly growing tissues. Folic acid-deficiency anemia is tired, weak, apathetic, and may have headaches, irregular heartbeats, and labored breathing, a sore tongue, intestinal injury, diarrhea, lack of appetite, weight loss, irritability and forgetfulness. Folic acid is widely distributed in foods. Liver, dark green leafy vegetables, fruit, and yeast are good sources. Some folic acid is synthesized by bacteria in the intestines.