Cobalamin and folate are closely related and deficiencies in one can affect levels of the other. Cobalamin is found in animal products and is important for older adults and those with absorption issues. Folate is found in vegetables and fruits and deficiencies can lead to anemia and birth defects. Deficiencies in both can cause behavioral and physical symptoms.
Cobalamin and folate are related because they both affect the body closely, and a deficiency or excess in one can affect levels of the other nutrient. For example, a person with low cobalamin levels may develop a folate deficiency. Someone with existing low cobalamin levels supplementing their diet with only folate will likely make the cobalamin deficiency worse. It is important to obtain adequate levels of both cobalamin and folate. Consuming large amounts of folic acid, either through food or supplements, can hide an existing cobalamin deficiency by correcting otherwise visible symptoms.
Vitamin B-12 is the common name for cobalamin. It is available in animal products, such as fish, poultry, meat, eggs, and milk. It is also added to cereals and breads, and is present in most basic vitamin formulations. The recommended dietary allowance for cobalamin is 2.4 micrograms (mcg) daily.
Most healthy people in developed countries have a sufficient intake of cobalamin. Older adults and people who have trouble absorbing nutrients through digestion, such as those with reduced levels of stomach acid, intestinal disorders, and people with pernicious anemia, are at higher risk of experiencing a cobalamin deficiency. It is estimated that between 1.5 and 15 percent of the population in developed countries have some level of cobalamin deficiency. Symptoms of a cobalamin deficiency include fatigue, constipation, loss of appetite, weight loss, weakness, and megaloblastic anemia, a condition in which red blood cells are larger than normal. A deficiency is usually treated with injections of B-12, to avoid absorption problems.
Folate is a water soluble B vitamin. The synthetic version of folate is called folic acid. Folate is found in green leafy vegetables, as well as other vegetables such as asparagus and okra, fruits such as melons and bananas, lentils and other legumes, mushrooms, orange and tomato juice, and organ meats. A deficiency in folate can lead to megaloblastic anemia, as well as increased pregnancy loss and birth defects.
The recommended daily dose of folic acid is 400 mcg. Adequate levels of folic acid reduce homocystin levels in the blood, help the body produce red blood cells, aid in protein metabolism, and aid in cell growth and division. Many breads and cereals are fortified with folic acid, making deficiencies relatively rare in developed countries.
A blood test to determine if a patient is deficient in both cobalamin and folate may be ordered if the individual exhibits behavioral or mental changes, such as irritability, depression, or paranoia. A deficiency of cobalamin and folic acid is particularly likely to be a factor in behavioral changes in the elderly. Physical symptoms that may indicate a deficiency in both nutrients include unexplained fatigue, weakness, dizziness, or pain in the mouth and tongue.
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