Imbalances in vitamin B12 and folate levels in the blood can affect various body systems and promote or mask disease. Anemia, cognitive difficulties, and cardiovascular disease have been associated with an imbalance. Medications and diseases can also cause deficiencies in these nutrients. Taking vitamin B12 and folic acid together can lower blood homocysteine levels.
The relationship between vitamin B12 and folate can be beneficial or harmful depending on the levels of each in the blood. Studies have shown that an imbalance in intake or absorption of vitamin B12 and folate can affect various body systems and promote or mask disease, particularly when blood levels of vitamin B12 are low and folate levels are high. Cognitive difficulties, risk of cardiovascular disease, and a type of anemia have been associated with an imbalance in vitamin B12 and folate.
When difficulties arise from a blood imbalance in vitamin B12 and folate, they usually manifest in the elderly as problems with memory, visual and spatial abilities, and the maintenance of attention. These problems develop when people over the age of 60 have low levels of vitamin B12 and high levels of folate. Conversely, when older people have normal B12 levels and high or normal folate levels, they tend to score better on cognitive tests.
Anemia has been found most often in older people with low vitamin B12 and high folate blood. However, there is also folate deficiency anemia, for which doctors often prescribe large amounts of folic acid, the synthetic form of folate. Before offering folic acid supplements for anemia, clinicians should determine which type is being treated, as high doses of folic acid can mask a vitamin B12 deficiency and allow that untreated deficiency to cause neurological damage in the patient.
On the plus side, there is some evidence that taking vitamin B12 and folic acid together can lower blood homocysteine levels. As an amino acid used by the body to make certain proteins, homocysteine in elevated concentrations is associated with increased risk of stroke, heart disease, and Alzheimer’s disease. In some studies, researchers found that adding vitamin B6 to vitamin B12 and folic acid supplements may help lower homocysteine levels.
Deficiencies in vitamin B12 and folic acid can be caused by some medications. Oral contraceptives, some antibiotics, and estrogen supplements can lower blood levels of vitamin B12. Other medications, including large doses of aspirin and ibuprofen, blood pressure medications, anticonvulsants, and antiulcer preparations, can inhibit folate absorption. Methotrexate, a medication used to treat autoimmune diseases such as rheumatoid arthritis, lupus, psoriasis, and scleroderma, is also known to inhibit folate absorption.
There are additional reasons why vitamin B12 and folate levels may vary from normal. Some diseases can cause malabsorption of both nutrients, including alcoholism, celiac disease, and Crohn’s disease. Folate and vitamin B12 malabsorption can also be caused by aging, gastric inflammation, and tapeworm infections.
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