Annual Health Exam Guide: Key Vitamin deficiencies - Vitamin B12, Calcium & Vitamin D

Vitamins are essential in small amounts for normal metabolism. Because most vitamins cannot be synthesized by humans, they need to be ingested in the diet to maintain health and prevent disease.The exceptions to this are pre-vitamin D3, which is synthesized in the skin following ultraviolet (UV) exposure, and vitamins K2 and B12, which can be synthesized by gut microbes.

Vitamins should be distinguished from minerals (such as calcium and iron), many of which are also essential micronutrients.

Multivitamins offer some extra vitamins and minerals you may occasionally lack from your regular diet, but they are not a replacement for healthy eating. Taking them does not offer any special health benefits or disease protection. Additionally, taking vitamins to prevent or reverse chronic diseases generally does not work, and can potentially be harmful.

Pregnancy, lactation, alcohol consumption, and chronic use of certain medications also increase certain vitamin requirements.

This article will be focusing on Vitamin B12 & Vitamin D. We will also touch base on Calcium deficiency.

B12 Deficiency

Vitamin B12 deficiency has become a common health issue in India and around the globe. Reports suggest at least 47% of the Indian population suffers from low B12 levels.

Function of B12 in our body

Vitamin B12 is essential for red blood cell formation, cell metabolism, nerve function, and the production of DNA – the carrier of our genetic information.

Sources of vitamin B-12

Poultry, meat, fish and dairy products are all rich in B12. Vitamin B-12 is also added to some foods, such as fortified breakfast cereals, and is available as an oral supplement.

Risk factors for deficiency

There are many risk factors for B12 deficiency based on your lifestyle and demographics. Below are some of the most common risk factors:

People who follow a vegetarian or vegan diet, because plant foods don't contain vitamin B12.

Older adults and people with digestive tract conditions that affect absorption of nutrients may not be able to absorb the required amount of vitamin.

People with genetic predispositions or Pernicious Anemia (an autoimmune condition that prevents the body from absorbing b12)

Alcoholism can cause significant B12 deficiency.

The chronic use of several medications can also result in B12 deficiency, some common medications are Metformin when taken for more than 4 months, and acid lowering medications (Pepcid, omeprazole, pantoprazole) when taken more than 12 months.

Symptoms of B12 deficiency

B12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage – causing tingling & numbness, mood disturbances. Older adults may have memory problems from deficiency.

Treatment

Based on the level of deficiency and symptoms, either an oral supplement or injections will be recommended.

Unless you have a vitamin B12 deficiency, there's no evidence that vitamin B12 supplements will boost your energy or make you a better athlete.

Safety and side effects

When taken at appropriate doses, vitamin B12 supplements are generally considered safe. While the recommended daily amount of vitamin B12 for adults is 2.4 micrograms, higher doses have been found to be safe. Your body absorbs only as much as it needs, and any excess passes through your urine.

Calcium deficiency

Hypocalcemia, or low levels of calcium in the blood, can lead to calcium deficiency symptoms. To boost calcium levels, a doctor may recommend eating more calcium-rich foods or taking calcium supplements.Many Indians (staying in India) consume diets that are low in calcium. This deficiency is prevalent in both vegetarian and non-vegetarian diets and is linked to various health issues.

Function of calcium in our body

Calcium is essential for building and maintaining strong bones and teeth. It also plays a role in muscle contraction, nerve signal transmission, blood clotting, and hormone release. A long-term calcium deficiency can lead to dental changes, cataracts, alterations in the brain, and osteoporosis, which causes the bones to become brittle

Food sources of calcium

Your body doesn't produce calcium, so you must get it through other sources. To absorb calcium, your body also needs vitamin D.

Calcium can be found in a variety of foods, including:

• Dairy products, such as cheese, milk and yogurt

• Dark green leafy vegetables, such as broccoli and kale

• Fish with edible soft bones, such as sardines and canned salmon

• Calcium-fortified foods and beverages, such as soy products, cereal and fruit juices, and milk substitutes

Risk factors for calcium deficiency

The most common risk factor for calcium deficiency is a vitamin D deficiency. Since vitamin D is required to absorb calcium, low levels of vitamin D can result in calcium deficiency, so it’s important to get your levels of Vitamin D checked.

Some other common risk factors are:

• Following a vegan diet

• Lactose intolerance, or not eating dairy

• Consuming large amounts of protein or sodium (commonly in packaged & processed foods), which can cause your body to excrete more calcium

• Long-term treatment with corticosteroids

• Certain bowel or digestive diseases that decrease your ability to absorb calcium, such as inflammatory bowel disease or celiac disease

• Parathyroid disorder or thyroid removal surgery

• Family history of genetic conditions,such as certain genetic mutations, genetic Vitamin D disorder or DiGeorge syndrome.

Symptoms of calcium deficiency

Mild deficiency may not cause any symptoms, but you can have muscle aches, brittle nails, dry skin & tingling numbness. Severe deficiency can cause heart rhythm disturbances or seizures. A long-term calcium deficiency can lead to dental changes, cataracts, alterations in the brain, and osteoporosis, which causes the bones to become brittle.

Treatment

Most adults need 1000-1,200 mg of calcium daily. A calcium supplement is only needed if you are deficient or if your doctor advises you for prevention of fractures in osteoporosis.

The two main forms of calcium supplements are carbonate and citrate. Calcium carbonate is cheapest and therefore often a good first choice. Calcium supplements can interact with many different prescription medications, including blood pressure medications, synthetic thyroid hormones, bisphosphonates, antibiotics and calcium channel blockers. The best way to take calcium supplements is in between your meals.

As with any health concern, it’s important to talk to your Primary Care Physician to determine what dosage is right for you.

Vitamin D deficiency

A vitamin D deficiency occurs when you do not have enough vitamin D in your body. This is a problem because the body needs vitamin D for several important purposes, including absorbing calcium.

People who do not have enough vitamin D can:

• Have weak or soft bones, which can break easily or change in shape

• Have weak muscles, which makes them more likely to fall

Risk factors for Vitamin D deficiency

• Spending most or all of your time indoors

• Medical problems (such as celiac disease) that make it hard for you to absorb vitamin D

• Darker skin pigmentation, older age & obesity.

Sources of Vitamin D

• Milk, orange juice, or yogurt with vitamin D added

• Salmon or mackerel

• Canned tuna fish

• Cereals with vitamin D added

• Cod liver oil

• Sun rays

• Lastly, supplements are another way people can get vitamin D.

Treatment

Experts recommend that most adults take supplements that have 600 to 800 international units of vitamin D each day. This is the same as 15 to 20 micrograms of vitamin D. People who do not get enough vitamin D from their food or from the sun might need to take even more.

If your doctor recommends that you take vitamin D supplements, ask which type, how much, and when to take them. The type and dose of supplement that is right for you depends on your medical problems and the other medicines you take.

It is important not to take too much vitamin D. Taking too much vitamin D can make you sick.

It is not a good idea to try to get vitamin D by spending time in the sun or using tanning beds. This can lead to sunburn and increase your risk of skin cancer.

Please do not hesitate to reach out to me for any questions on this topic!

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Smita Saraf, MD, FAAFP